Graphical user interface for laser eye surgery system

ABSTRACT

Methods and systems for planning and forming incisions in a cornea, lens capsule, and/or crystalline lens nucleus are disclosed. A method includes measuring spatial dispositions, relative to a laser surgery system, of at least portions of the corneal anterior and posterior surfaces. A spatial disposition of an incision of the cornea is generated based at least in part on the measured corneal anterior and posterior spatial dispositions and at least one corneal incision parameter. A composite image is displayed that includes an image representative of the measured corneal anterior and posterior surfaces and an image representing the corneal incision.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of and claims priority to U.S. patentapplication Ser. No. 16/915,736, filed Jun. 29, 2020, which is adivisional of and claims priority to U.S. patent application Ser. No.14/062,448, filed Oct. 24, 2013, which claims the benefit of priority toU.S. Provisional Application No. 61/718,156, filed Oct. 24, 2012 andU.S. Provisional Application No. 61/722,037, filed Nov. 2, 2012. All ofthe above-referenced applications are incorporated herein by referencein their entireties.

BACKGROUND

Cataract extraction is one of the most commonly performed surgicalprocedures in the world. A cataract is formed by opacification of thecrystalline lens or its envelope—the lens capsule—of the eye. Thecataract obstructs passage of light through the lens. A cataract canvary in degree from slight to complete opacity. Early in the developmentof an age-related cataract the power of the lens may be increased,causing near-sightedness (myopia). Gradual yellowing and opacificationof the lens may reduce the perception of blue colors as thosewavelengths are absorbed and scattered within the crystalline lens.Cataract formation typically progresses slowly resulting in progressivevision loss. Cataracts are potentially blinding if untreated.

A common cataract treatment involves replacing the opaque crystallinelens with an artificial intraocular lens (IOL). Presently, an estimated15 million cataract surgeries per year are performed worldwide. Thecataract treatment market is composed of various segments includingintraocular lenses for implantation, viscoelastic polymers to facilitatesurgical procedures, and disposable instrumentation including ultrasonicphacoemulsification tips, tubing, various knives, and forceps.

Presently, cataract surgery is typically performed using a techniquetermed phacoemulsification in which an ultrasonic tip with associatedirrigation and aspiration ports is used to sculpt the relatively hardnucleus of the lens to facilitate removal through an opening made in theanterior lens capsule. The nucleus of the lens is contained within anouter membrane of the lens that is referred to as the lens capsule.Access to the lens nucleus can be provided by performing an anteriorcapsulotomy in which a small (often round) hole is formed in theanterior side of the lens capsule. Access to the lens nucleus can alsobe provided by performing a manual continuous curvilinear capsulorhexis(CCC) procedure. After removal of the lens nucleus, a synthetic foldableintraocular lens (IOL) can be inserted into the remaining lens capsuleof the eye. Typically, the IOL is held in place by the edges of theanterior capsule and the capsular bag. The IOL may also be held by theposterior capsule, either alone or in unison with the anterior capsule.This latter configuration is known in the field as a “Bag-in-Lens”implant.

One of the most technically challenging and critical steps in thecataract extraction procedure is providing access to the lens nucleus.The manual continuous curvilinear capsulorhexis (CCC) procedure evolvedfrom an earlier technique termed can-opener capsulotomy in which a sharpneedle was used to perforate the anterior lens capsule in a circularfashion followed by the removal of a circular fragment of lens capsuletypically in the range of mm in diameter. The smaller the capsulotomy,the more difficult it is to produce manually. The capsulotomy providesaccess for the next step of nuclear sculpting by phacoemulsification.Due to a variety of complications associated with the initial can-openertechnique, attempts were made by leading experts in the field to developa better technique for removal of the circular fragment of the anteriorlens capsule prior to the emulsification step.

The desired outcome of the manual continuous curvilinear capsulorhexisis to provide a smooth continuous circular opening through which notonly the phacoemulsification of the nucleus can be performed safely andeasily, but also to provide for easy insertion of the intraocular lens.The resulting opening in the anterior lens capsule provides access fortool insertion during removal of the nucleus and for IOL insertion, apermanent aperture for transmission of the image to the retina of thepatient, and also support of the IOL inside the remaining lens capsulethat limits the potential for dislocation. The resulting reliance on theshape, symmetry, uniformity, and strength of the remaining lens capsuleto contain, constrain, position, and maintain the IOL in the patient'seye limits the placement accuracy of the IOL, both initially and overtime. Subsequently, a patient's refractive outcome and resultant visualacuity are less deterministic and intrinsically sub-optimal due to theIOL placement uncertainty. This is especially true for astigmatismcorrecting (“toric”) and accommodating (“presbyopic”) IOLs.

Problems may also develop related to inability of the surgeon toadequately visualize the lens capsule due to lack of red reflex, tograsp the lens capsule with sufficient security, and to tear a smoothcircular opening in the lens capsule of the appropriate size and in thecorrect location without creating radial rips and extensions. Alsopresent are technical difficulties related to maintenance of the depthof the anterior chamber depth after opening the lens capsule, smallpupils, or the absence of a red reflex due to the lens opacity. Some ofthe problems with visualization can be minimized through the use of dyessuch as methylene blue or indocyanine green. Additional complicationsmay also arise in patients with weak zonules (typically older patients)and very young children that have very soft and elastic lens capsules,which are very difficult to controllably and reliably rupture and tear.

The implantation of a “Bag-in-Lens” IOL typically uses anterior andposterior openings in the lens capsule of the same size. Manuallycreating matching anterior and posterior capsulotomies for the“Bag-in-Lens” configuration, however, is particularly difficult.

Many cataract patients have astigmatic visual errors. Astigmatism canoccur when the corneal curvature is unequal in all directions. An IOLcan be used to correct for astigmatism but require precise rotationaland central placement. Additionally, IOLs are not typically used forcorrection beyond 5D of astigmatism. Many patients, however, haveastigmatic visual errors exceeding 5D. Higher correction beyond 5Dtypically requires reshaping the cornea to make it more spherical. Thereare numerous existing approaches for reshaping the cornea, includingCorneaplasty, Astigmatic Keratotomy, Corneal Relaxing Incision (CRI),and Limbal Relaxing Incision (LRI). In Astigmatic Keratotomy, CornealRelaxing Incision (CRI), and Limbal Relaxing Incision (LRI), cornealincisions are made in a well-defined manner and depth to allow thecornea to change shape to become more spherical. Presently, thesecorneal incisions are typically accomplished manually often with limitedprecision.

Thus, improved methods and systems for treating cataracts and/orcreating corneal incisions are needed.

SUMMARY

Methods and systems related to laser eye surgery use a laser to formprecise incisions in the cornea (e.g., one or more cataract accessincisions and/or one or more arcuate incisions), in the lens capsule,and/or in the crystalline lens nucleus. Control of the laser eye surgerycan include treatment planning prior to coupling a patient's eye to alaser surgery system, coupling of the patient's eye to the laser surgerysystem, imaging of the patient's eye to measure the spatial dispositionsof the cornea and lens relative to the laser eye surgery system,treatment planning using the measured spatial dispositions of the corneaand lens, and control the laser to automatically form the plannedincisions in the patient's eye in an accurate fashion relative to themeasured structures of the patient's eye. In many embodiments, the lasereye surgery system includes graphical user interface (GUI) to facilitateuser control of the treatment planning, patient coupling, and thetreatment procedure.

In many embodiments, the laser eye surgery system automaticallygenerates surface and curved line models corresponding to the anteriorsurface of the cornea, the posterior surface of the cornea, the anteriorportion of the lens capsule, the posterior portion of the lens capsule,the iris, the pupil, and the limbus. The laser eye surgery system candisplay composite images that include representations of the measuredeye structures and representations of the generated surface and/orcurved line models for user verification of the accuracy of theautomatically generated surface and/or curved line models. In manyembodiments, the operator of the laser eye surgery system canselectively modify the generated surface and/or curved models ifdesired, for example, to better match the measured eye structure.

Thus, in one aspect, a method is provided for planning a laser surgeryprocedure on an eye having a cornea, a pupil, and a lens. The cornea hasan anterior surface and a posterior surface. The lens is disposed withina lens capsule having an anterior portion and a posterior portion. Themethod includes coupling the eye to a laser surgery system operable tomeasure a spatial disposition of an internal structure of the eyerelative to the laser surgery system. A spatial disposition of at leasta portion of the corneal anterior surface is measured by using the lasersurgery system. A spatial disposition of at least a portion of thecorneal posterior surface is measured by using the laser surgery system.A spatial disposition of an incision of the cornea is generated based atleast in part on the measured corneal anterior and posterior spatialdispositions and at least one corneal incision parameter. And acomposite image is displayed that includes an image representative ofthe measured corneal anterior and posterior surfaces and an imagerepresenting the corneal incision.

Variations of the method for planning a laser surgery procedure can beperformed. For example, the at least one corneal incision parameter caninclude a corneal incision line density parameter to control amount ofoverlap between adjacent lines of laser pulse focus points that will beused to form the corneal incision. The corneal incision can extendpartially through the cornea so as to leave an uncut region of thecornea aligned with one or more cut portions of the corneal incision,the corneal incision and the uncut region of the cornea defining anaccess path for a cataract surgery instrument. The method can includealtering the at least one corneal incision parameter in response to userinput; generating a spatial disposition of an altered incision of thecornea based at least in part on the measured corneal anterior andposterior spatial dispositions and the altered corneal incisionparameter; and displaying a second composite image that includes animage representative of the measured corneal anterior and posteriorsurfaces and an image representing the altered corneal incision. Themethod can include measuring a spatial disposition of at least a portionof the anterior portion of the lens capsule by using the laser surgerysystem; generating a spatial disposition of a capsulotomy incision ofthe anterior portion of the lens capsule based at least in part on themeasured spatial disposition of the anterior portion of the lens capsuleand at least one capsulotomy parameter; and displaying a third compositeimage that includes an image representative of the measured anteriorportion of the lens capsule and an image representing the capsulotomyincision. The at least one capsulotomy parameter can include acapsulotomy line density parameter to control amount of overlap betweenadjacent lines of laser pulse focus points that will be used to form thecapsulotomy incision. The method can include altering the at least onecapsulotomy parameter in response to user input; generating a spatialdisposition of an altered capsulotomy incision of the anterior portionof the lens capsule based at least in part on the measured cornealanterior and posterior spatial dispositions and the altered capsulotomyparameter; and displaying a fourth composite image that includes animage representative of the measured anterior portion of the lenscapsule and an image representing the altered capsulotomy incision. Themethod can include measuring a spatial disposition of at least a portionof the posterior portion of the lens capsule by using the laser surgerysystem; generating a spatial disposition of a lens fragmentationincision pattern of the lens based at least in part on the measuredspatial dispositions of the anterior and posterior portions of the lenscapsule and at least one lens fragmentation parameter; and displaying afifth composite image that includes an image representative of themeasured anterior and posterior portions of the lens capsule and animage representing the lens fragmentation incision pattern. The at leastone lens fragmentation parameter can include a lens fragmentation linedensity parameter to control amount of overlap between adjacent lines oflaser pulse focus points that will be used to form the lensfragmentation incision pattern. The method can include altering the atleast one lens fragmentation parameter in response to user input;generating a spatial disposition of an altered lens fragmentationincision pattern of the lens based at least in part on the measuredspatial dispositions of the anterior and posterior portions of the lenscapsule and the altered at least one lens fragmentation parameter; anddisplaying a sixth composite image that includes an image representativeof the measured anterior and posterior portions of the lens capsule andan image representing the altered lens fragmentation incision pattern.The method can include generating a spatial disposition of a safetyvolume within the lens, the incision pattern not overlapping the safetyvolume, the safety volume separating the lens fragmentation incisionpattern from the anterior and posterior portions of the lens capsule andseparating the lens fragmentation pattern transverse to the pupil suchthat a maximum transverse width of the lens fragmentation pattern isless than a diameter of the pupil; and displaying a safety volume imagethat includes a representation of the safety volume. The method caninclude, prior to the coupling of the eye to the laser surgery system,displaying a seventh composite image that includes an imagerepresentative of the eye and at least one of an image representing anincision of the cornea corresponding to the at least one cornealincision parameter, an image representing an incision of the anteriorportion of the lens capsule corresponding to the at least onecapsulotomy parameter, or an image representing a lens fragmentationincision pattern corresponding to the at least one lens fragmentationparameter. The method can include, prior to the coupling of the eye tothe laser surgery system, generating a spatial disposition of a safetyvolume within the lens, the incision pattern not overlapping the safetyvolume, the safety volume separating the lens fragmentation incisionpattern from the anterior and posterior portions of the lens capsule andseparating the lens fragmentation pattern transverse to the pupil suchthat a maximum transverse width of the lens fragmentation pattern isless than a diameter of the pupil; and displaying a safety volume imagethat includes a representation of the safety volume.

In another aspect, a method is provided for planning a laser surgeryprocedure of an eye having a cornea and a lens capsule. The methodincludes coupling the eye to a laser surgery system operable to measurespatial dispositions of, relative to the laser surgery system, thecornea and the lens capsule; generating and displaying a firstcross-sectional image of the eye based at least in part on measuredspatial dispositions of the cornea and lens capsule, the firstcross-sectional image including at least one of a cross section of thecornea and a cross section of a central portion of the lens capsule;receiving user input designating a plurality of points in the firstcross-sectional image corresponding to points on a boundary surface ofthe cornea or the lens capsule; generating and displaying a secondcross-sectional image of the eye based at least in part on the measuredspatial dispositions of the cornea and lens capsule, the secondcross-sectional image being transverse to the first cross-sectionalimage and including at least one of a cross section of the cornea and across section of a central portion of the lens capsule; receiving userinput designating a plurality of points in the second cross-sectionalimage corresponding to points on the boundary surface; generating asurface model of the boundary surface based on the user designatedpoints; and generating a spatial disposition of an incision of thecornea or the lens capsule based at least in part on the surface modeland at least one incision parameter.

In another aspect, a system is provided for planning and performing alaser surgery procedure on an eye having a cornea, a pupil, a limbus,and a lens. The cornea has an anterior surface and a posterior surface.The lens is disposed within a lens capsule having an anterior portionand a posterior portion. The system includes a laser source configuredto produce a treatment beam that includes a plurality of laser pulses;an integrated optical system that includes an imaging assemblyoperatively coupled to a treatment laser delivery assembly for thetreatment beam such that the imaging assembly and the treatment laserdelivery system share at least one common optical element, theintegrated optical system being configured to locate at least a portionof the corneal anterior surface and at least a portion of the cornealposterior surface; a patient interface configured to couple the eye withthe integrated optical system so as to constrain the position of the eyerelative to the integrated optical system; a display device; and acontroller operatively coupled with the display device, the lasersource, and the integrated optical system. The controller is configuredto generate, relative to the integrated optical system, a spatialdisposition of the corneal anterior surface and a spatial disposition ofthe corneal posterior surface by using the integrated optical system tolocate at least portions of the corneal anterior and posterior surfaces;generate a spatial disposition of an incision of the cornea using thegenerated spatial dispositions of the corneal anterior and posteriorsurfaces and at least one corneal incision parameter; and display acomposite image on the display device, the composite image including animage representative of the generated spatial dispositions of thecorneal anterior and posterior surfaces and an image representing thecorneal incision.

Variations of the system for planning and performing a laser surgeryprocedure on an eye are possible. For example, the at least one cornealincision parameter can include a corneal incision line density parameterto control amount of overlap between adjacent lines of laser pulse focuspoints that will be used to form the corneal incision. The cornealincision can extend partially through the cornea so as to leave an uncutregion of the cornea aligned with one or more cut portions of thecorneal incision, the corneal incision and the uncut region of thecornea defining an access path for a cataract surgery instrument. Thesystem can include a user input device. The controller can be configuredto alter the at least one corneal incision parameter in response to userinput via the user input device; generate a spatial disposition of analtered incision of the cornea using the generated corneal anterior andposterior spatial dispositions and the altered corneal incisionparameter; and display a second composite image on the display device,the second composite image including an image representative of thegenerated spatial dispositions of the corneal anterior and posteriorsurfaces and an image representing the altered corneal incision. Theintegrated optical system can be configured to locate at least a portionof the anterior portion of the lens capsule. The controller can beconfigured to generate a spatial disposition of at least a portion ofthe anterior portion of the lens capsule by using the integrated opticalsystem to locate at least a portion of the anterior portion of the lenscapsule; generate a spatial disposition of a capsulotomy incision of theanterior portion of the lens capsule using the generated spatialdisposition of the anterior portion of the lens capsule and at least onecapsulotomy parameter; and display a third composite image on thedisplay device, the third composite image including an imagerepresentative of the generated spatial disposition of the anteriorportion of the lens capsule and an image representing the capsulotomyincision. The at least one capsulotomy parameter can include acapsulotomy line density parameter to control amount of overlap betweenadjacent lines of laser pulse focus points that will be used to form thecapsulotomy incision. The controller can be configured to alter the atleast one capsulotomy parameter in response to user input via the userinput device; generate a spatial disposition of an altered capsulotomyincision of the anterior portion of the lens capsule using the generatedanterior lens capsule spatial disposition and the altered capsulotomyparameter; and display a fourth composite image on the display device,the fourth composite image including an image representative of thegenerated spatial disposition of the anterior portion of the lenscapsule and an image representing the altered capsulotomy incision. Theintegrated optical system can be configured to locate at least a portionof the posterior portion of the lens capsule. The controller can beconfigured to generate a spatial disposition of at least a portion ofthe posterior portion of the lens capsule by using the integratedoptical system to locate at least the portion of the posterior portionof the lens capsule; generate a spatial disposition of a lensfragmentation incision pattern of the lens using the generated spatialdisposition of the posterior portion of the lens capsule and at leastone lens fragmentation parameter; and display a fifth composite image onthe display device, the fifth composite image including an imagerepresentative of the generated spatial dispositions of the anterior andposterior portions of the lens capsule and an image representing thelens fragmentation incision pattern. The at least one lens fragmentationparameter can include a lens fragmentation line density parameter tocontrol amount of overlap between adjacent lines of laser pulse focuspoints that will be used to form the lens fragmentation incisionpattern. The controller can be configured to alter the at least one lensfragmentation parameter in response to user input via the user inputdevice; generate a spatial disposition of an altered lens fragmentationincision pattern using the generated spatial dispositions of theanterior and posterior portions of the lens capsule and the altered atleast one lens fragmentation parameter; and display a sixth compositeimage on the display device, the sixth composite image including animage representative of the generated spatial dispositions of thecorneal anterior and posterior surfaces and an image representing thealtered lens fragmentation incision pattern. The controller beingfurther configured to generate a spatial disposition of a safety volumewithin the lens, the incision pattern not overlapping the safety volume,the safety volume separating the lens fragmentation incision patternfrom the anterior and posterior portions of the lens capsule andseparating the lens fragmentation pattern transverse to the pupil suchthat a maximum transverse width of the lens fragmentation pattern isless than a diameter of the pupil; and display a safety volume imagethat includes a representation of the safety volume. The controller canbe configured to, prior to coupling the eye to the integrated opticalsystem, generate a spatial disposition of a safety volume within thelens, the incision pattern not overlapping the safety volume, the safetyvolume separating the lens fragmentation incision pattern from theanterior and posterior portions of the lens capsule and separating thelens fragmentation pattern transverse to the pupil such that a maximumtransverse width of the lens fragmentation pattern is less than adiameter of the pupil; and display a safety volume image that includes arepresentation of the safety volume.

In another aspect, a system is provided for planning and performing alaser surgery procedure on an eye having a cornea, a pupil, and a lens.The cornea has an anterior surface and a posterior surface. The lens isdisposed within a lens capsule having an anterior portion and aposterior portion. The system includes a laser source configured toproduce a treatment beam that includes a plurality of laser pulses; anintegrated optical system that includes an imaging assembly operativelycoupled to a treatment laser delivery assembly for the treatment beamsuch that the imaging assembly and the treatment laser delivery systemshare at least one common optical element, the integrated optical systembeing configured to locate at least a portion of the corneal anteriorsurface and at least a portion of the corneal posterior surface; apatient interface configured to couple the eye with the integratedoptical system so as to constrain the position of the eye relative tothe integrated optical system; a display device; and a controlleroperatively coupled with the display device, the laser source, and theintegrated optical system. The controller is configured to generate anddisplay a first cross-sectional image of the eye based at least in parton spatial dispositions of the cornea and lens capsule measured by theintegrated optics system, the first cross-sectional image including atleast one of a cross section of the cornea and a cross section of acentral portion of the lens capsule; receive user input designating aplurality of points in the first cross-sectional image corresponding topoints on a boundary surface of the cornea or the lens capsule; generateand display a second cross-sectional image of the eye based at least inpart on the measured spatial dispositions of the cornea and lenscapsule, the second cross-sectional image being transverse to the firstcross-sectional image and including at least one of a cross section ofthe cornea and a cross section of a central portion of the lens capsule;receive user input designating a plurality of points in the secondcross-sectional image corresponding to points on the boundary surface;generate a surface model of the boundary surface based at least in parton the user designated points; and generate a spatial disposition of anincision of the cornea or the lens capsule based at least in part on thesurface model and at least one incision parameter.

INCORPORATION BY REFERENCE

All publications, patents, and patent applications mentioned in thisspecification are herein incorporated by reference to the same extent asif each individual publication, patent, or patent application wasspecifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe appended claims. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1 is a perspective view showing a laser eye surgery system, inaccordance with many embodiments.

FIG. 2 is a simplified block diagram showing a top level view of theconfiguration of a laser eye surgery system, in accordance with manyembodiments.

FIG. 3 is a simplified block diagram illustrating the configuration ofan optical assembly of a laser eye surgery system, in accordance withmany embodiments.

FIG. 4 is a simplified block diagram of functionality provided by alaser eye surgery system, in accordance with many embodiments.

FIG. 5 is a simplified block diagram showing types of incisions that canbe planned and formed by a laser eye surgery system, in accordance withmany embodiments.

FIGS. 6 through 85 show example screens of graphical user interface(GUI) of a laser eye surgery system, in accordance with manyembodiments.

FIGS. 86 and 87 illustrate aspects of a capsulotomy incision of theanterior portion of the lens capsule, in accordance with manyembodiments.

FIGS. 88 and 89 illustrate aspects of lens fragmentation incisions, inaccordance with many embodiments.

FIGS. 90 through 92 illustrate aspect of arcuate incisions of a cornea,in accordance with many embodiments.

FIGS. 93 through 98 illustrate aspects of primary cataract incisions ofa cornea, in accordance with many embodiments.

FIGS. 99 through 103 illustrate aspects of sideport cataract incisionsof a cornea, in accordance with many embodiments.

FIGS. 104A through 104D illustrate alignments for sideport cataractincisions of the cornea, in accordance with many embodiments.

FIG. 105 illustrates a z-axis iris safety margin for all cornealincisions, in accordance with many embodiments.

FIG. 106 illustrates a lens anterior safety margin for all cornealincisions, in accordance with many embodiments.

FIG. 107 illustrates exemplary navigation icons used in a graphical userinterface for a laser eye surgery system according to embodiments of thepresent invention.

FIG. 108 illustrates exemplary information icons used in the graphicaluser interface according to embodiments of the present invention.

FIG. 109 illustrates exemplary lens fragmentation icons used in thegraphical user interface according to embodiments of the presentinvention.

DETAILED DESCRIPTION

Methods and systems related to laser eye surgery are disclosed. A laseris used to form precise incisions in the cornea, in the lens capsule,and/or in the crystalline lens nucleus. Control of the laser eye surgerycan include treatment planning prior to coupling a patient's eye to alaser surgery system, coupling of the patient's eye to the laser surgerysystem, imaging of the patient's eye including the cornea and lens,treatment planning after the patient's eye has been coupled to the lasersurgery system, and forming precise incisions in the cornea, in the lenscapsule, and/or in the crystalline lens nucleus. In many embodiments,the laser eye surgery system includes graphical user interface (GUI) tofacilitate user control of the treatment planning, patient coupling, andthe treatment procedure.

Prior to coupling the patient's eye to the laser eye surgery system, theGUI can be used to plan one or more cataract incisions (both primary andsecondary) in the cornea, one or more arcuate incisions in the cornea, acapsulotomy incision in the anterior portion of the lens capsule, and/orlens fragmentation incisions in the crystalline lens nucleus. Anydesired combination of cataract incision(s), arcuate incision(s),capsulotomy incision, and lens fragmentation incisions can be selectedand planned. In many embodiments, the GUI displays planning screens thatdisplay a composite image that includes an image of a modelrepresentation of an eye and an image representing the plannedincision(s). For each type of incision (i.e., cataract incision(s),arcuate incision(s), capsulotomy incision, and lens fragmentationincisions), the GUI can display an anterior view of the composite imageand/or a cross-sectional view of the composite image. The compositeimages are shown on planning screens on which associated incisionparameters (e.g., length, depth, location, etc. . . . ) are displayedand through which a user can selectively modify the associated incisionparameters. The composite images provide the user with visual feedbackregarding the configuration of the incisions selected such that the usercan adjust the associated incision parameters until desired incisionconfigurations are achieved.

In many embodiments, the GUI displays docking screens that guide theuser through docking a patient's eye to the laser eye surgery system.Such guidance can include guidance to install/replace a disposable lens,guidance to couple a suction ring to the patient's eye, guidance to addfluid to the suction ring and maneuver a patient chair to position thesuction ring to be coupled with the laser eye surgery system, guidanceto maneuver the patient chair to minimize forces exerted on thepatient's eye and to position the patients eye correctly, and guidanceto verify the patient interface has fluid present with no bubbles.

In many embodiments, the laser eye surgery system scans the patient'seye to measure the spatial disposition, relative to the laser eyesurgery system, of structures of the patient's eye, including theanterior and posterior surfaces of the cornea, anterior and posteriorportions of the lens capsule, the iris, and the limbus. The laser eyesurgery system can automatically generate surface models correspondingto the anterior surface of the cornea, the posterior surface of thecornea, the anterior portion of the lens capsule, the posterior portionof the lens capsule, and the iris. The laser eye surgery system can alsoautomatically generate curved line models corresponding to the limbusand the pupil. In many embodiments, the GUI displays composite imagesthat include representations of the measured structures of the patient'seye and representations corresponding to the automatically generatedsurface models and/or curved line models. In many embodiments, the GUIprovides the ability for the user to selectively modify the generatedsurface models and/or the curved line models. In many embodiments, theplanned incisions are based on the surface models and curved linemodels, either as automatically generated or user modified.

System Configuration

FIG. 1 shows a laser eye surgery system 2, in accordance with manyembodiments, operable to form precise incisions in the cornea, in thelens capsule, and/or in the crystalline lens nucleus. The system 2includes a main unit 4, a patient chair 6, a dual function footswitch 8,and a laser footswitch 10.

The main unit 4 includes many primary subsystems of the system 2. Forexample, externally visible subsystems include a touch-screen controlpanel 12, a patient interface assembly 14, patient interface vacuumconnections 16, a docking control keypad 18, a patient interface radiofrequency identification (RFID) reader 20, external connections 22(e.g., network, video output, footswitch, USB port, door interlock, andAC power), laser emission indicator 24, emergency laser stop button 26,key switch 28, and USB data ports 30.

The patient chair 6 includes a base 32, a patient support bed 34, aheadrest 36, a positioning mechanism, and a patient chair joystickcontrol 38 disposed on the headrest 36. The positioning controlmechanism is coupled between the base 32 and the patient support bed 34and headrest 36. The patient chair 6 is configured to be adjusted andoriented in three axes (x, y, and z) using the patient chair joystickcontrol 38. The headrest 36 and a restrain system (not shown, e.g., arestraint strap engaging the patient's forehead) stabilize the patient'shead during the procedure. The headrest 36 includes an adjustable necksupport to provide patient comfort and to reduce patient head movement.The headrest 36 is configured to be vertically adjustable to enableadjustment of the patient head position to provide patient comfort andto accommodate variation in patient head size.

The patient chair 6 allows for tilt articulation of the patient's legs,torso, and head using manual adjustments. The patient chair 6accommodates a patient load position, a suction ring capture position,and a patient treat position. In the patient load position, the chair 6is rotated out from under the main unit 4 with the patient chair back inan upright position and patient footrest in a lowered position. In thesuction ring capture position, the chair is rotated out from under themain unit 4 with the patient chair back in reclined position and patientfootrest in raised position. In the patient treat position, the chair isrotated under the main unit 4 with the patient chair back in reclinedposition and patient footrest in raised position.

The patient chair 6 is equipped with a “chair enable” feature to protectagainst unintended chair motion. The patient chair joystick 38 can beenabled in either of two ways. First, the patient chair joystick 38incorporates a “chair enable” button located on the top of the joystick.Control of the position of the patient chair 6 via the joystick 38 canbe enabled by continuously pressing the “chair enable” button.Alternately, the left foot switch 40 of the dual function footswitch 8can be continuously depressed to enable positional control of thepatient chair 6 via the joystick 38.

In many embodiments, the patient control joystick 38 is a proportionalcontroller. For example, moving the joystick a small amount can be usedto cause the chair to move slowly. Moving the joystick a large amountcan be used to cause the chair to move faster. Holding the joystick atits maximum travel limit can be used to cause the chair to move at themaximum chair speed. The available chair speed can be reduced as thepatient approaches the patient interface assembly 14.

The emergency stop button 26 can be pushed to stop emission of all laseroutput, release vacuum that couples the patient to the system 2, anddisable the patient chair 6. The stop button 26 is located on the systemfront panel, next to the key switch 28.

The key switch 28 can be used to enable the system 2. When in a standbyposition, the key can be removed and the system is disabled. When in aready position, the key enables power to the system 2.

The dual function footswitch 8 is a dual footswitch assembly thatincludes the left foot switch 40 and a right foot switch 42. The leftfoot switch 40 is the “chair enable” footswitch. The right footswitch 42is a “vacuum ON” footswitch that enables vacuum to secure a liquidoptics interface suction ring to the patient's eye. The laser footswitch10 is a shrouded footswitch that activates the treatment laser whendepressed while the system is enabled.

In many embodiments, the system 2 includes external communicationconnections. For example, the system 2 can include a network connection(e.g., an RJ45 network connection) for connecting the system 2 to anetwork. The network connection can be used to enable network printingof treatment reports, remote access to view system performance logs, andremote access to perform system diagnostics. The system 2 can include avideo output port (e.g., HDMI) that can be used to output video oftreatments performed by the system 2. The output video can be displayedon an external monitor for, for example, viewing by family membersand/or training. The output video can also be recorded for, for example,archival purposes. The system 2 can include one or more data outputports (e.g., USB) to, for example, enable export of treatment reports toa data storage device. The treatments reports stored on the data storagedevice can then be accessed at a later time for any suitable purposesuch as, for example, printing from an external computer in the casewhere the user without access to network based printing.

FIG. 2 shows a simplified block diagram of the system 2 coupled with apatient eye 43. The patient eye 43 comprises a cornea, a lens, and aniris. The iris defines a pupil of the eye 43 that may be used foralignment of eye 43 with system 2. The system 2 includes a cutting lasersubsystem 44, a ranging subsystem 46, an alignment guidance system 48,shared optics 50, a patient interface 52, control electronics 54, acontrol panel/GUI 56, user interface devices 58, and communication paths60. The control electronics 54 is operatively coupled via thecommunication paths 60 with the cutting laser subsystem 44, the rangingsubsystem 46, the alignment guidance subsystem 48, the shared optics 50,the patient interface 52, the control panel/GUI 56, and the userinterface devices 58.

In many embodiments, the cutting laser subsystem 44 incorporatesfemtosecond (FS) laser technology. By using femtosecond lasertechnology, a short duration (e.g., approximately 10⁻¹³ seconds induration) laser pulse (with energy level in the micro joule range) canbe delivered to a tightly focused point to disrupt tissue, therebysubstantially lowering the energy level required as compared to thelevel required for ultrasound fragmentation of the lens nucleus and ascompared to laser pulses having longer durations.

The cutting laser subsystem 44 can produce laser pulses having awavelength suitable to the configuration of the system 2. As anon-limiting example, the system 2 can be configured to use a cuttinglaser subsystem 44 that produces laser pulses having a wavelength from1020 nm to 1050 nm. For example, the cutting laser subsystem 44 can havea diode-pumped solid-state configuration with a 1030 (+/−5) nm centerwavelength.

The cutting laser subsystem 44 can include control and conditioningcomponents. For example, such control components can include componentssuch as a beam attenuator to control the energy of the laser pulse andthe average power of the pulse train, a fixed aperture to control thecross-sectional spatial extent of the beam containing the laser pulses,one or more power monitors to monitor the flux and repetition rate ofthe beam train and therefore the energy of the laser pulses, and ashutter to allow/block transmission of the laser pulses. Suchconditioning components can include an adjustable zoom assembly to adaptthe beam containing the laser pulses to the characteristics of thesystem 2 and a fixed optical relay to transfer the laser pulses over adistance while accommodating laser pulse beam positional and/ordirectional variability, thereby providing increased tolerance forcomponent variation.

The ranging subsystem 46 is configured to measure the spatialdisposition of eye structures in three dimensions. The measured eyestructures can include the anterior and posterior surfaces of thecornea, the anterior and posterior portions of the lens capsule, theiris, and the limbus. In many embodiments, the ranging subsystem 46utilizes optical coherence tomography (OCT) imaging. As a non-limitingexample, the system 2 can be configured to use an OCT imaging systememploying wavelengths from 780 nm to 970 nm. For example, the rangingsubsystem 46 can include an OCT imaging system that employs a broadspectrum of wavelengths from 810 nm to 850 nm. Such an OCT imagingsystem can employ a reference path length that is adjustable to adjustthe effective depth in the eye of the OCT measurement, thereby allowingthe measurement of system components including features of the patientinterface that lie anterior to the cornea of the eye and structures ofthe eye that range in depth from the anterior surface of the cornea tothe posterior portion of the lens capsule and beyond.

The alignment guidance subsystem 48 can include a laser diode or gaslaser that produces a laser beam used to align optical components of thesystem 2. The alignment guidance subsystem 48 can include LEDs or lasersthat produce a fixation light to assist in aligning and stabilizing thepatient's eye during docking and treatment. The alignment guidancesubsystem 48 can include a laser or LED light source and a detector tomonitor the alignment and stability of the actuators used to positionthe beam in X, Y, and Z. The alignment guidance subsystem 48 can includea video system that can be used to provide imaging of the patient's eyeto facilitate docking of the patient's eye 43 to the patient interface52. The imaging system provided by the video system can also be used todirect via the GUI the location of cuts. The imaging provided by thevideo system can additionally be used during the laser eye surgeryprocedure to monitor the progress of the procedure, to track movementsof the patient's eye 43 during the procedure, and to measure thelocation and size of structures of the eye such as the pupil and/orlimbus.

The shared optics 50 provides a common propagation path that is disposedbetween the patient interface 52 and each of the cutting laser subsystem44, the ranging subsystem 46, and the alignment guidance subsystem 48.In many embodiments, the shared optics 50 includes beam combiners toreceive the emission from the respective subsystem (e.g., the cuttinglaser subsystem 44, and the alignment guidance subsystem 48) andredirect the emission along the common propagation path to the patientinterface. In many embodiments, the shared optics 50 includes anobjective lens assembly that focuses each laser pulse into a focalpoint. In many embodiments, the shared optics 50 includes scanningmechanisms operable to scan the respective emission in three dimensions.For example, the shared optics can include an XY-scan mechanism(s) and aZ-scan mechanism. The XY-scan mechanism(s) can be used to scan therespective emission in two dimensions transverse to the propagationdirection of the respective emission. The Z-scan mechanism can be usedto vary the depth of the focal point within the eye 43. In manyembodiments, the scanning mechanisms are disposed between the laserdiode and the objective lens such that the scanning mechanisms are usedto scan the alignment laser beam produced by the laser diode. Incontrast, in many embodiments, the video system is disposed between thescanning mechanisms and the objective lens such that the scanningmechanisms do not affect the image obtained by the video system.

The patient interface 52 is used to restrain the position of thepatient's eye 43 relative to the system 2. In many embodiments, thepatient interface 52 employs a suction ring that is vacuum attached tothe patient's eye 43. The suction ring is then coupled with the patientinterface 52, for example, using vacuum to secure the suction ring tothe patient interface 52. In many embodiments, the patient interface 52includes an optically transmissive structure having a posterior surfacethat is displaced vertically from the anterior surface of the patient'scornea and a region of a suitable liquid (e.g., a sterile bufferedsaline solution (BSS) such as Alcon BSS (Alcon Part Number 351-55005-1)or equivalent) is disposed between and in contact with the posteriorsurface and the patient's cornea and forms part of a transmission pathbetween the shared optics 50 and the patient's eye 43. The opticallytransmissive structure may comprise a lens 96 having one or more curvedsurfaces. Alternatively, the patient interface 22 may comprise anoptically transmissive structure having one or more substantially flatsurfaces such as a parallel plate or wedge. In many embodiments, thepatient interface lens is disposable and can be replaced at any suitableinterval, such as before each eye treatment.

The control electronics 54 controls the operation of and can receiveinput from the cutting laser subsystem 44, the ranging subsystem 46, thealignment guidance subsystem 48, the patient interface 52, the controlpanel/GUI 56, and the user interface devices 58 via the communicationpaths 60. The communication paths 60 can be implemented in any suitableconfiguration, including any suitable shared or dedicated communicationpaths between the control electronics 54 and the respective systemcomponents.

The control electronics 54 can include any suitable components, such asone or more processor, one or more field-programmable gate array (FPGA),and one or more memory storage devices. In many embodiments, the controlelectronics 54 controls the control panel/GUI 56 to provide forpre-procedure planning according to user specified treatment parametersas well as to provide user control over the laser eye surgery procedure.

The control electronics 54 may comprise a processor/controller 55(referred to herein as a processor) that is used to perform calculationsrelated to system operation and provide control signals to the varioussystem elements. A computer readable medium 57 (also referred to as adatabase or a memory) is coupled to the processor 55 in order to storedata used by the processor and other system elements. The processor 55interacts with the other components of the system as described morefully throughout the present specification. In an embodiment, the memory57 can include a look up table that can be utilized to control one ormore components of the laser system as described herein.

The processor 55 can be a general purpose microprocessor configured toexecute instructions and data, such as a Pentium processor manufacturedby the Intel Corporation of Santa Clara, California. It can also be anApplication Specific Integrated Circuit (ASIC) that embodies at leastpart of the instructions for performing the method in accordance withthe embodiments of the present disclosure in software, firmware and/orhardware. As an example, such processors include dedicated circuitry,ASICs, combinatorial logic, other programmable processors, combinationsthereof, and the like.

The memory 57 can be local or distributed as appropriate to theparticular application. Memory 57 may include a number of memoriesincluding a main random access memory (RAM) for storage of instructionsand data during program execution and a read only memory (ROM) in whichfixed instructions are stored. Thus, memory 57 provides persistent(non-volatile) storage for program and data files, and may include ahard disk drive, flash memory, a floppy disk drive along with associatedremovable media, a Compact Disk Read Only Memory (CD-ROM) drive, anoptical drive, removable media cartridges, and other like storage media.

The user interface devices 58 can include any suitable user input devicesuitable to provide user input to the control electronics 54. Forexample, the user interface devices 58 can include devices such as, forexample, the dual function footswitch 8, the laser footswitch 10, thedocking control keypad 18, the patient interface radio frequencyidentification (RFID) reader 20, the emergency laser stop button 26, thekey switch 28, and the patient chair joystick control 38.

FIG. 3 is a simplified block diagram illustrating an assembly 62, inaccordance with many embodiments, that can be included in the system 2.The assembly 62 is a non-limiting example of suitable configurations andintegration of the cutting laser subsystem 44, the ranging subsystem 46,the alignment guidance subsystem 48, the shared optics 50, and thepatient interface 52. Other configurations and integration of thecutting laser subsystem 44, the ranging subsystem 46, the alignmentguidance subsystem 48, the shared optics 50, and the patient interface52 may be possible and may be apparent to a person of skill in the art.

The assembly 62 is operable to project and scan optical beams into thepatient's eye 43. The cutting laser subsystem 44 includes an ultrafast(UF) laser 64 (e.g., a femtosecond laser). Using the assembly 62,optical beams can be scanned in the patient's eye 43 in threedimensions: X, Y, Z. For example, short-pulsed laser light generated bythe UF laser 64 can be focused into eye tissue to produce dielectricbreakdown to cause photodisruption around the focal point (the focalzone), thereby rupturing the tissue in the vicinity of the photo-inducedplasma. In the assembly 62, the wavelength of the laser light can varybetween 800 nm to 1200 nm and the pulse width of the laser light canvary from 10 fs to 10000 fs. The pulse repetition frequency can alsovary from 10 kHz to 500 kHz. Safety limits with regard to unintendeddamage to non-targeted tissue bound the upper limit with regard torepetition rate and pulse energy. Threshold energy, time to complete theprocedure, and stability can bound the lower limit for pulse energy andrepetition rate. The peak power of the focused spot in the eye 43 andspecifically within the crystalline lens and the lens capsule of the eyeis sufficient to produce optical breakdown and initiate aplasma-mediated ablation process. Near-infrared wavelengths for thelaser light are preferred because linear optical absorption andscattering in biological tissue is reduced for near-infraredwavelengths. As an example, the laser 64 can be a repetitively pulsed1031 nm device that produces pulses with less than 600 fs duration at arepetition rate of 120 kHz (+/−5%) and individual pulse energy in the 1to 20 micro joule range.

The cutting laser subsystem 44 is controlled by the control electronics54 and the user, via the control panel/GUI 56 and the user interfacedevices 58, to create a laser pulse beam 66. The control panel/GUI 56 isused to set system operating parameters, process user input, displaygathered information such as images of ocular structures, and displayrepresentations of incisions to be formed in the patient's eye 43.

The generated laser pulse beam 66 proceeds through a zoom assembly 68.The laser pulse beam 66 may vary from unit to unit, particularly whenthe UF laser 64 may be obtained from different laser manufacturers. Forexample, the beam diameter of the laser pulse beam 66 may vary from unitto unit (e.g., by +/−20%). The beam may also vary with regard to beamquality, beam divergence, beam spatial circularity, and astigmatism. Inmany embodiments, the zoom assembly 68 is adjustable such that the laserpulse beam 66 exiting the zoom assembly 68 has consistent beam diameterand divergence unit to unit.

After exiting the zoom assembly 68, the laser pulse beam 66 proceedsthrough an attenuator 70. The attenuator 70 is used to adjust thetransmission of the laser beam and thereby the energy level of the laserpulses in the laser pulse beam 66. The attenuator 70 is controlled viathe control electronics 54.

After exiting the attenuator 70, the laser pulse beam 66 proceedsthrough an aperture 72. The aperture 72 sets the outer useful diameterof the laser pulse beam 66. In turn the zoom determines the size of thebeam at the aperture location and therefore the amount of light that istransmitted. The amount of transmitted light is bounded both high andlow. The upper is bounded by the requirement to achieve the highestnumerical aperture achievable in the eye. High NA promotes low thresholdenergies and greater safety margin for untargeted tissue. The lower isbound by the requirement for high optical throughput. Too muchtransmission loss in the system shortens the lifetime of the system asthe laser output and system degrades over time. Additionally,consistency in the transmission through this aperture promotes stabilityin determining optimum settings (and sharing of) for each procedure.Typically to achieve optimal performance the transmission through thisaperture as set to be between 88% to 92%.

After exiting the aperture 72, the laser pulse beam 66 proceeds throughtwo output pickoffs 74. Each output pickoff 74 can include a partiallyreflecting mirror to divert a portion of each laser pulse to arespective output monitor 76. Two output pickoffs 74 (e.g., a primaryand a secondary) and respective primary and secondary output monitors 76are used to provide redundancy in case of malfunction of the primaryoutput monitor 76.

After exiting the output pickoffs 74, the laser pulse beam 66 proceedsthrough a system-controlled shutter 78. The system-controlled shutter 78ensures on/off control of the laser pulse beam 66 for procedural andsafety reasons. The two output pickoffs precede the shutter allowing formonitoring of the beam power, energy, and repetition rate as apre-requisite for opening the shutter.

After exiting the system-controlled shutter 78, the optical beamproceeds through an optics relay telescope 80. The optics relaytelescope 80 propagates the laser pulse beam 66 over a distance whileaccommodating positional and/or directional variability of the laserpulse beam 66, thereby providing increased tolerance for componentvariation. As an example, the optical relay can be a keplerian afocaltelescope that relays an image of the aperture position to a conjugateposition near to the xy galvo mirror positions. In this way, theposition of the beam at the XY galvo location is invariant to changes inthe beams angle at the aperture position. Similarly the shutter does nothave to precede the relay and may follow after or be included within therelay.

After exiting the optics relay telescope 80, the laser pulse beam 66 istransmitted to the shared optics 50, which propagates the laser pulsebeam 66 to the patient interface 52. The laser pulse beam 66 is incidentupon a beam combiner 82, which reflects the laser pulse beam 66 whiletransmitting optical beams from the ranging subsystem 46 and thealignment guidance subsystem: AIM 48.

Following the beam combiner 82, the laser pulse beam 66 continuesthrough a Z-telescope 84, which is operable to scan focus position ofthe laser pulse beam 66 in the patient's eye 43 along the Z axis. Forexample, the Z-telescope 84 can include a Galilean telescope with twolens groups (each lens group includes one or more lenses). One of thelens groups moves along the Z axis about the collimation position of theZ-telescope 84. In this way, the focus position of the spot in thepatient's eye 43 moves along the Z axis. In general, there is arelationship between the motion of lens group and the motion of thefocus point. For example, the Z-telescope can have an approximate 2×beam expansion ratio and close to a 1:1 relationship of the movement ofthe lens group to the movement of the focus point. The exactrelationship between the motion of the lens and the motion of the focusin the Z axis of the eye coordinate system does not have to be a fixedlinear relationship. The motion can be nonlinear and directed via amodel or a calibration from measurement or a combination of both.Alternatively, the other lens group can be moved along the Z axis toadjust the position of the focus point along the Z axis. The Z-telescope84 functions as a Z-scan device for scanning the focus point of thelaser-pulse beam 66 in the patient's eye 43. The Z-telescope 84 can becontrolled automatically and dynamically by the control electronics 54and selected to be independent or to interplay with the X- and Y-scandevices described next.

After passing through the Z-telescope 84, the laser pulse beam 66 isincident upon an X-scan device 86, which is operable to scan the laserpulse beam 66 in the X direction, which is dominantly transverse to theZ axis and transverse to the direction of propagation of the laser pulsebeam 66. The X-scan device 86 is controlled by the control electronics54, and can include suitable components, such as a motor, galvanometer,or any other well known optic moving device. The relationship of themotion of the beam as a function of the motion of the X actuator doesnot have to be fixed or linear. Modeling or calibrated measurement ofthe relationship or a combination of both can be determined and used todirect the location of the beam.

After being directed by the X-scan device 86, the laser pulse beam 66 isincident upon a Y-scan device 88, which is operable to scan the laserpulse beam 66 in the Y direction, which is dominantly transverse to theX and Z axes. The Y-scan device 88 is controlled by the controlelectronics 54, and can include suitable components, such as a motor,galvanometer, or any other well known optic moving device. Therelationship of the motion of the beam as a function of the motion ofthe Y actuator does not have to be fixed or linear. Modeling orcalibrated measurement of the relationship or a combination of both canbe determined and used to direct the location of the beam.Alternatively, the functionality of the X-scan device 86 and the Y-scandevice 88 can be provided by an XY-scan device configured to scan thelaser pulse beam 66 in two dimensions transverse to the Z axis and thepropagation direction of the laser pulse beam 66. The X-scan and Y-scandevices 86, 88 change the resulting direction of the laser pulse beam66, causing lateral displacements of UF focus point located in thepatient's eye 43.

After being directed by the Y-scan device 88, the laser pulse beam 66passes through a beam combiner 90. The beam combiner 90 is configured totransmit the laser pulse beam 66 while reflecting optical beams to andfrom a video subsystem 92 of the alignment guidance subsystem 48.

After passing through the beam combiner 90, the laser pulse beam 66passes through an objective lens assembly 94. The objective lensassembly 94 can include one or more lenses. In many embodiments, theobjective lens assembly 94 includes multiple lenses. The complexity ofthe objective lens assembly 94 may be driven by the scan field size, thefocused spot size, the degree of telecentricity, the available workingdistance on both the proximal and distal sides of objective lensassembly 94, as well as the amount of aberration control.

After passing through the objective lens assembly 94, the laser pulsebeam 66 passes through the patient interface 52. As described above, inmany embodiments, the patient interface 52 includes a patient interfacelens 96 having a posterior surface that is displaced vertically from theanterior surface of the patient's cornea and a region of a suitableliquid (e.g., a sterile buffered saline solution (B S S) such as AlconBSS (Alcon Part Number 351-55005-1) or equivalent) is disposed betweenand in contact with the posterior surface of the patient interface lens96 and the patient's cornea and forms part of an optical transmissionpath between the shared optics 50 and the patient's eye 43.

The shared optics 50 under the control of the control electronics 54 canautomatically generate aiming, ranging, and treatment scan patterns.Such patterns can be comprised of a single spot of light, multiple spotsof light, a continuous pattern of light, multiple continuous patterns oflight, and/or any combination of these. In addition, the aiming pattern(using the aim beam 108 described below) need not be identical to thetreatment pattern (using the laser pulse beam 66), but can optionally beused to designate the boundaries of the treatment pattern to provideverification that the laser pulse beam 66 will be delivered only withinthe desired target area for patient safety. This can be done, forexample, by having the aiming pattern provide an outline of the intendedtreatment pattern. This way the spatial extent of the treatment patterncan be made known to the user, if not the exact locations of theindividual spots themselves, and the scanning thus optimized for speed,efficiency, and/or accuracy. The aiming pattern can also be made to beperceived as blinking in order to further enhance its visibility to theuser. Likewise, the ranging beam 102 need not be identical to thetreatment beam or pattern. The ranging beam needs only to be sufficientenough to identify targeted surfaces. These surfaces can include thecornea and the anterior and posterior surfaces of the lens and may beconsidered spheres with a single radius of curvature. Also the opticsshared by the alignment guidance: video subsystem does not have to beidentical to those shared by the treatment beam. The positioning andcharacter of the laser pulse beam 66 and/or the scan pattern the laserpulse beam 66 forms on the eye 43 may be further controlled by use of aninput device such as a joystick, or any other appropriate user inputdevice (e.g., control panel/GUI 56) to position the patient and/or theoptical system.

The control electronics 54 can be configured to target the targetedstructures in the eye 43 and ensure that the laser pulse beam 66 will befocused where appropriate and not unintentionally damage non-targetedtissue. Imaging modalities and techniques described herein, such asthose mentioned above, or ultrasound may be used to determine thelocation and measure the thickness of the lens and lens capsule toprovide greater precision to the laser focusing methods, including 2Dand 3D patterning. Laser focusing may also be accomplished by using oneor more methods including direct observation of an aiming beam, or otherknown ophthalmic or medical imaging modalities, such as those mentionedabove, and/or combinations thereof. Additionally the ranging subsystemsuch as an OCT can be used to detect features or aspects involved withthe patient interface. Features can include fiducials placed on thedocking structures and optical structures of the disposable lens such asthe location of the anterior and posterior surfaces.

In the embodiment of FIG. 3 , the ranging subsystem 46 includes an OCTimaging device. Additionally or alternatively, imaging modalities otherthan OCT imaging can be used. An OCT scan of the eye can be used tomeasure the spatial disposition (e.g., three dimensional coordinatessuch as X, Y, and Z of points on boundaries) of structures of interestin the patient's eye 43. Such structure of interest can include, forexample, the anterior surface of the cornea, the posterior surface ofthe cornea, the anterior portion of the lens capsule, the posteriorportion of the lens capsule, the anterior surface of the crystallinelens, the posterior surface of the crystalline lens, the iris, thepupil, and/or the limbus. The spatial disposition of the structures ofinterest and/or of suitable matching geometric modeling such as surfacesand curves can be generated and/or used by the control electronics 54 toprogram and control the subsequent laser-assisted surgical procedure.The spatial disposition of the structures of interest and/or of suitablematching geometric modeling can also be used to determine a wide varietyof parameters related to the procedure such as, for example, the upperand lower axial limits of the focal planes used for cutting the lenscapsule and segmentation of the lens cortex and nucleus, and thethickness of the lens capsule among others. Additionally the rangingsubsystem such as an OCT can be used to detect features or aspectsinvolved with the patient interface. Features can include fiducialsplaced on the docking structures and optical structures of thedisposable lens such as the location of the anterior and posteriorsurfaces.

The ranging subsystem 46 in FIG. 3 includes an OCT light source anddetection device 98. The OCT light source and detection device 98includes a light source that generates and emits an OCT source beam witha suitable broad spectrum. For example, in many embodiments, the OCTlight source and detection device 98 generates and emits the OCT sourcebeam with a broad spectrum from 810 nm to 850 nm wavelength. Thegenerated and emitted light is coupled to the device 98 by a single modefiber optic connection.

The OCT source beam emitted from the OCT light source and detectiondevice 98 is passed through a pickoff/combiner assembly 100, whichdivides the OCT source beam into a sample beam 102 and a referenceportion 104. A significant portion of the sample beam 102 is transmittedthrough the shared optics 50. A relative small portion of the samplebeam is reflected from the patient interface 52 and/or the patient's eye43 and travels back through the shared optics 50, back through thepickoff/combiner assembly 100 and into the OCT light source anddetection device 98. The reference portion 104 is transmitted along areference path 106 having an adjustable path length. The reference path106 is configured to receive the reference portion 104 from thepickoff/combiner assembly 100, propagate the reference portion 104 overan adjustable path length, and then return the reference portion 106back to the pickoff/combiner assembly 100, which then directs thereturned reference portion 104 back to the OCT light source anddetection device 98. The OCT light source and detection device 98 thendirects the returning small portion of the sample beam 102 and thereturning reference portion 104 into a detection assembly, which employsa time domain detection technique, a frequency detection technique, or asingle point detection technique. For example, a frequency domaintechnique can be used with an OCT wavelength of 830 nm and bandwidth of100 nm.

Once combined with the UF laser pulse beam 66 subsequent to the beamcombiner 82, the OCT sample beam 102 follows a shared path with the UFlaser pulse beam 66 through the shared optics 50 and the patientinterface 52. In this way, the OCT sample beam 102 is generallyindicative of the location of the UF laser pulse beam 66. Similar to theUF laser beam, the OCT sample beam 102 passes through the Z-telescope84, is redirected by the X-scan device 86 and by the Y-scan device 88,passes through the objective lens assembly 94 and the patient interface52, and on into the eye 43. Reflections and scatter off of structureswithin the eye provide return beams that retrace back through thepatient interface 52, back through the shared optics 50, back throughthe pickoff/combiner assembly 100, and back into the OCT light sourceand detection device 98. The returning back reflections of the samplebeam 102 are combined with the returning reference portion 104 anddirected into the detector portion of the OCT light source and detectiondevice 98, which generates OCT signals in response to the combinedreturning beams. The generated OCT signals that are in turn interpretedby the control electronics to determine the spatial disposition of thestructures of interest in the patient's eye 43. The generated OCTsignals can also be interpreted by the control electronics to measurethe position and orientation of the patient interface 52, as well as todetermine whether there is liquid disposed between the posterior surfaceof the patient interface lens 96 and the patient's eye 43.

The OCT light source and detection device 98 works on the principle ofmeasuring differences in optical path length between the reference path106 and the sample path. Therefore, different settings of theZ-telescope 84 to change the focus of the UF laser beam do not impactthe length of the sample path for an axially stationary surface in theeye of patient interface volume because the optical path length does notchange as a function of different settings of the Z-telescope 84. Theranging subsystem 46 has an inherent Z range that is related to thelight source and detection scheme, and in the case of frequency domaindetection the Z range is specifically related to the spectrometer, thewavelength, the bandwidth, and the length of the reference path 106. Inthe case of ranging subsystem 46 used in FIG. 3 , the Z range isapproximately 4-5 mm in an aqueous environment. Extending this range toat least 20-25 mm involves the adjustment of the path length of thereference path via a stage ZED 106 within ranging subsystem 46. Passingthe OCT sample beam 102 through the Z-telescope 84, while not impactingthe sample path length, allows for optimization of the OCT signalstrength. This is accomplished by focusing the OCT sample beam 102 ontothe targeted structure. The focused beam both increases the returnreflected or scattered signal that can be transmitted through the singlemode fiber and increases the spatial resolution due to the reducedextent of the focused beam. The changing of the focus of the sample OCTbeam can be accomplished independently of changing the path length ofthe reference path 106.

Because of the fundamental differences in how the sample beam 102 (e.g.,810 nm to 850 nm wavelengths) and the UF laser pulse beam 66 (e.g., 1020nm to 1050 nm wavelengths) propagate through the shared optics 50 andthe patient interface 52 due to influences such as immersion index,refraction, and aberration, both chromatic and monochromatic, care mustbe taken in analyzing the OCT signal with respect to the UF laser pulsebeam 66 focal location. A calibration or registration procedure as afunction of X, Y, and Z can be conducted in order to match the OCTsignal information to the UF laser pulse beam focus location and also tothe relative to absolute dimensional quantities.

There are many suitable possibilities for the configuration of the OCTinterferometer. For example, alternative suitable configurations includetime and frequency domain approaches, single and dual beam methods,swept source, etc, are described in U.S. Pat. Nos. 5,748,898; 5,459,570;6,111,645; and 6,053,613.

The system 2 can be set to locate the anterior and posterior surfaces ofthe lens capsule and cornea and ensure that the UF laser pulse beam 66will be focused on the lens capsule and cornea at all points of thedesired opening. Imaging modalities and techniques described herein,such as for example, Optical Coherence Tomography (OCT), and such asPurkinje imaging, Scheimpflug imaging, confocal or nonlinear opticalmicroscopy, fluorescence imaging, ultrasound, structured light, stereoimaging, or other known ophthalmic or medical imaging modalities and/orcombinations thereof may be used to determine the shape, geometry,perimeter, boundaries, and/or 3-dimensional location of the lens andlens capsule and cornea to provide greater precision to the laserfocusing methods, including 2D and 3D patterning. Laser focusing mayalso be accomplished using one or more methods including directobservation of an aiming beam, or other known ophthalmic or medicalimaging modalities and combinations thereof, such as but not limited tothose defined above.

Optical imaging of the cornea, anterior chamber, and lens can beperformed using the same laser and/or the same scanner used to producethe patterns for cutting. Optical imaging can be used to provideinformation about the axial location and shape (and even thickness) ofthe anterior and posterior lens capsule, the boundaries of the cataractnucleus, as well as the depth of the anterior chamber and features ofthe cornea. This information may then be loaded into the laser 3-Dscanning system or used to generate a three dimensionalmodel/representation/image of the cornea, anterior chamber, and lens ofthe eye, and used to define the cutting patterns used in the surgicalprocedure.

Observation of an aim beam can also be used to assist in positioning thefocus point of the UF laser pulse beam 66. Additionally, an aim beamvisible to the unaided eye in lieu of the infrared OCT sample beam 102and the UF laser pulse beam 66 can be helpful with alignment providedthe aim beam accurately represents the infrared beam parameters. Thealignment guidance subsystem 48 is included in the assembly 62 shown inFIG. 3 . An aim beam 108 is generated by an aim beam light source 110,such as a laser diode in the 630-650 nm range.

Once the aim beam light source 110 generates the aim beam 108, the aimbeam 108 is transmitted along an aim path 112 to the shared optics 50,where it is redirected by a beam combiner 114. After being redirected bythe beam combiner 114, the aim beam 108 follows a shared path with theUF laser pulse beam 66 through the shared optics 50 and the patientinterface 52. In this way, the aim beam 108 is indicative of thelocation of the UF laser pulse beam 66. The aim beam 108 passes throughthe Z-telescope 84, is redirected by the X-scan device 86 and by theY-scan device 88, passes through the beam combiner 90, passes throughthe objective lens assembly 94 and the patient interface 52, and on intothe patient's eye 43.

The video subsystem 92 is operable to obtain images of the patientinterface and the patient's eye. The video subsystem 92 includes acamera 116, an illumination light source 118, and a beam combiner 120.The video subsystem 92 gathers images that can be used by the controlelectronics 54 for providing pattern centering about or within apredefined structure. The illumination light source 118 can be generallybroadband and incoherent. For example, the light source 118 can includemultiple LEDs. The wavelength of the illumination light source 118 ispreferably in the range of 700 nm to 750 nm, but can be anything that isaccommodated by the beam combiner 90, which combines the light from theillumination light source 118 with the beam path for the UF laser pulsebeam 66, the OCT sample beam 102, and the aim beam 108 (beam combiner 90reflects the video wavelengths while transmitting the OCT and UFwavelengths). The beam combiner 90 may partially transmit the aim beam108 wavelength so that the aim beam 108 can be visible to the camera116. An optional polarization element can be disposed in front of theillumination light source 118 and used to optimize signal. The optionalpolarization element can be, for example, a linear polarizer, a quarterwave plate, a half-wave plate or any combination. An additional optionalanalyzer can be placed in front of the camera. The polarizer analyzercombination can be crossed linear polarizers thereby eliminatingspecular reflections from unwanted surfaces such as the objective lenssurfaces while allowing passage of scattered light from targetedsurfaces such as the intended structures of the eye. The illuminationmay also be in a dark-field configuration such that the illuminationsources are directed to the independent surfaces outside the capturenumerical aperture of the image portion of the video system.Alternatively the illumination may also be in a bright fieldconfiguration. In both the dark and bright field configurations, theillumination light source may be used as a fixation beam for thepatient. The illumination may also be used to illuminate the patientspupil to enhance the pupil iris boundary to facilitate iris detectionand eye tracking. A false color image generated by the near infraredwavelength or a bandwidth thereof may be acceptable.

The illumination light from the illumination light source 118 istransmitted through the beam combiner 120 to the beam combiner 90. Fromthe beam combiner 90, the illumination light is directed towards thepatient's eye 43 through the objective lens assembly 94 and through thepatient interface 94. The illumination light reflected and scattered offof various structures of the eye 43 and patient interface travel backthrough the patient interface 94, back through the objective lensassembly 94, and back to the beam combiner 90. At the beam combiner 90,the returning light is directed back to the beam combiner 120 where thereturning light is redirected toward the camera 116. The beam combinercan be a cube, plate, or pellicle element. It may also be in the form ofa spider mirror whereby the illumination transmits past the outer extentof the mirror while the image path reflects off the inner reflectingsurface of the mirror. Alternatively, the beam combiner could be in theform of a scraper mirror where the illumination is transmitted through ahole while the image path reflects off of the mirrors reflecting surfacethat lies outside the hole. The camera 116 can be an suitable imagingdevice, for example but not limited to, any silicon based detector arrayof the appropriately sized format. A video lens forms an image onto thecamera's detector array while optical elements provide polarizationcontrol and wavelength filtering respectively. An aperture or irisprovides control of imaging NA and therefore depth of focus and depth offield and resolution. A small aperture provides the advantage of largedepth of field that aids in the patient docking procedure.Alternatively, the illumination and camera paths can be switched.Furthermore, the aim light source 110 can be made to emit infrared lightthat would not be directly visible, but could be captured and displayedusing the video subsystem 92.

System Functionality Overview

The laser eye surgery system 2 is an integrated scanning laser systemthat can be used by cataract surgeons to create a precise anteriorcapsulotomy and/or subsequent lens fragmentation of the crystallinelens, with or without single plane and multi-plane arc cuts/incisions inthe cornea. Treatment is accomplished through the use of ultrafast(τ˜10⁻¹³ s, or hundreds of femtoseconds [FS]) infrared laser pulses. Theranging subsystem 46 provides a three-dimensional image of the anteriorsegment of the eye and guides laser treatment. The shared optics 50 isused for both the ranging subsystem 46 and the cutting laser subsystem44 to provide inherent co-registration of the two optical subsystems.

Each FS laser pulse creates a highly localized plasma and subsequentcavitation event that disrupts only microns of tissue per pulse. In manyembodiments, treatment of the eye 43 consists of applying user-definedlaser patterns to the crystalline lens, lens capsule, and cornea of theeye to create incisions by applying FS laser pulses, guided by datagenerated by the ranging subsystem 46.

Treatment planning can be used to verify incision patterns prior totreatment. For example, intended treatment patterns can be presented tothe physician overlaid on cross-sectional images of the anterior segment(generated by using the ranging subsystem 46) for review/modificationbefore initiation of treatment of the eye 43.

The laser eye surgery system 2 is configured such that it can be used bya single operator. A graphical user interface (GUI) allows forpretreatment planning prior to coupling the patient's eye 43 to thepatient interface 52. The laser eye surgery system can be used in anysuitable type/location of treatment, for example, for in-patient orout-patient treatments performed in a hospital or in an AmbulatorySurgery Center (ASC).

User Interface

FIG. 4 is a simplified chart illustrating top-level functionality of thelaser eye surgery system 2 that is accessible to a user through the GUI.In many embodiments, the laser eye surgery system 2 is configured toenable management of system users (132); treatment planning prior tocoupling the patient's eye to the system (134); coupling of thepatient's eye to the system and related guidance (136); imaging ofinternal portions of the patient's eye including anterior and posteriorsurfaces of the cornea and the lens and lens capsule (138); treatmentverification, treatment replanning, and/or treatment planning based onthe imaging of internal portions of the patient's eye to generate andverify planned incisions based on measured spatial dispositions of theinternal portions of the patient's eye (140); treatment authorization(142); treating the patient's eye to form the planned incisions in thepatient's eye (144); decoupling of the patient's eye from the system andrelated guidance (146); and generation of a treatment report (148).

FIG. 5 is a top-level chart showing types of incisions that can beplanned and formed by the laser eye surgery system 2. The incisions thatcan be planned and formed by the laser eye surgery system 2 includecapsulotomy incisions (150), lens fragmentation incisions (152),cataract incisions (154), and arcuate incisions (156). A capsulotomyincision (150) is often formed in the anterior portion of the lenscapsule so as to provide access to a cataractous lens nucleus forremoval of the cataractous lens nucleus. The laser eye surgery system 2is operable to form a smooth circular opening in the anterior portion ofthe lens capsule. The lens fragmentation incisions (152) are formed inthe cataractous lens nucleus so as to fragment the lens into smallportions to aid in the removal of the lens nucleus. The cataractincisions (154) are formed in the cornea to provide access for surgicaltools used to remove the fragmented lens nucleus and through which anIOL can be passed for implantation to provide optical functioncompensating for the absence of the lens nucleus. The cataract incisions(154) are made in the cornea to provide access through the cornea forsurgical instruments used during cataract replacement surgery. Thecataract incision (154) can include primary incisions, which aretypically large enough that an IOL can be inserted through the primaryincision as well as surgical instruments used during cataractreplacement surgery, and secondary (or “sideport”) incisions, that aresmaller than the primary incisions and through which surgicalinstruments used during cataract replacement surgery can be inserted.The arcuate incisions (156) are made in the cornea and used to reshapethe cornea, thereby modifying the optical properties of the cornea.

The graphical user interface (GUI) is displayed on the touch-screencontrol panel 12 and features different types of control screensincluding administrative screens, planning screens, a surgical timeoutscreen, docking screens, treatment screens, and undocking screens. TheGUI and the touch-screen control panel 12 enables the user to press arespective portion of the touch-screen control panel 12 to eithernavigate within the GUI or initiate the entry of data for the parameterlisted at the selected portion of the touch-screen control panel 12.

The administrative screens can be used by a system administrator tomanage system users and allow users to log into, log out of, and shutdown the system. The planning screens can be used by users to create andedit treatment templates; to create, edit, and initiate treatment plans;to enable/disable the system; and to enable/disable the laser. Thesurgical timeout screen can be used to verify patient details andtreatment parameters before proceeding to the docking screens. Thedocking screens guide a user through the process of positioning thesuction ring, applying vacuum, and capturing the suction ring. Thetreatment screens allow a user to internally image the eye 43 using theranging subsystem 46, to verify and customize treatment parameters priorto laser treatment, and to initiate and monitor laser treatment. Theundocking screens guide a user through the process of releasing thepatient, removing a disposable portion of the patient interface 52, andreviewing the treatment report.

All planning screens and most treatment screens have a Quick Navigationbar at the bottom of the screen that allows a user to easily navigatebetween screens. Refer to FIG. 107 for a description of the icons in theQuick Navigation bar.

In addition to the icons in the Quick Navigation bar, there are twoicons that provide treatment-related information. Refer to FIG. 108 fora description of the informational icons.

In the Information Icons shown in FIG. 108 , the compass icon representsthe orientation of the selected eye: I=Inferior; S=Superior; T=Temporal;N=Nasal; A=Anterior; and P=Posterior. In the force icon, the coloredring provides a visual indication of the forces exerted on the patientinterface 52 by the eye 43. The ring is green when the forces exerted onthe patient interface are within a range acceptable for locking thesuction ring/disposable lens assembly to the system. The ring is yellowwhen the forces exerted on the patient interface rise to a level ofconcern. The ring is orange when the forces exerted on the patientinterface rise to a level that will stop scanning of the eye 43 by theranging subsystem 46 or a laser treatment. The ring is red when theforces exerted on the patient interface rise to an unacceptable level.In many embodiments, the system is configured to undock the patientafter a suitable time period (e.g., three seconds) if the ring is redduring the docking process. Likewise, the system can be configured toundock the patient after a suitable time period (e.g., immediately, 1second) if the ring is red during laser treatment.

The GUI includes a home screen for a system administrator (referred toherein as “administrator home screen”) and a home screen for generalusers (referred to herein as “home screen”). The administrator homescreen provides the administrator access to several features that arenot accessible to general users. From the administrator home screen, theadministrator can go to a Manage Users Screen, a Reports Screen, ManageTemplates Screen, and Settings Screen; verify system alignment; createnew treatment plans and edit previously created treatment plans;initiate a treatment plan; enable/disable the system and laser; viewtreatment activation status; return to the Login Screen; open a SoftwareInfo window; and access a Help Manual. FIG. 6 shows an exampleadministrator home screen. FIG. 8 shows an example Reports Screen. AndFIG. 9 shows an example Treatment Report Screen, which is accessiblefrom the Reports Screen, for a specific treatment.

From the Administrator Home Screen, pressing the MANAGE USERS button 200causes the Manage Users Screen shown in FIG. 7 to be displayed. From theManage Users Screen, the administrator can add user accounts; assignuser permission levels (e.g., Admin—user has administrator privileges,as described herein, General—user can plan and start treatments andperform system calibration and self-test, and Disabled—user has nopermissions); reset user passwords; view requests for user accountssubmitted from the Login Screen; sort users by name, requests, orpermissions; return to the Administrator Home Screen, access the HelpManual, and view treatment activation status.

From the Home Screen or Administrator Home Screen, pressing the ACTIVITYREPORT button 202 causes the Reports Screen (example shown in FIG. 8 )to be displayed. From the Reports Screen, a person can view a list ofpatients for whom there are incomplete, complete, and/or abortedtreatments; view a list of treatments for each patient; enable ordisable incomplete treatments; go to the Treatment Report Summary Screenfor the selected treatment; view the total number of treatmentsperformed; return to the Home Screen or Administrator Home Screen;access the Help Manual; and view treatment activation status.

From the Reports Screen, a specific patient can be selected to view alist of treatments for that patient. Selecting a specific treatment fromthe list, and then pressing the SHOW TREATMENT RESULTS 204 button causesthe Treatment Report Summary Screen (example shown in FIG. 9 ) for thattreatment to be displayed. From the Treatment Report Summary Screen, auser can view treatment results, save the treatment report as a PDFfile, print the treatment report to a network printer, return to theReports Screen, go to the Home Screen or Administrator Home Screen,access the Help Manual, and view treatment activation status.

FIG. 10 shows a login screen for general users. After logging into thelaser eye surgery system 2 as a general user, the home screen shown inFIG. 11 is displayed on the touch-screen control panel 12. From the homescreen, the general user can create new treatment plans and editpreviously created treatment plans; initiate a treatment plan;enable/disable the system and laser; go to the Login Info Screen,Reports Screen, and Manage Templates Screen; verify system alignment;view treatment activation status; return to the Login Screen; open aSoftware Info window; and access the Help Manual. During treatmentplanning, a user can return to the Home Screen at any time by pressingthe HOME button in the upper right corner of the treatment planningscreens.

From the Home Screen or Administrator Home Screen, pressing the MANAGETEMPLATES button 206 causes the Manage Templates Screen (example foradministrators shown in FIG. 12 and example for general users shown inFIG. 13 ) to be displayed. From the Manage Templates Screen foradministrators, a person can add new surgeon template sets and editpreviously created surgeon template sets, enable or disable surgeontemplate sets, copy surgeon template sets, return to the AdministratorHome Screen, access the Help Manual, and view treatment activationstatus. From the Manage Templates Screen for general users, a person canedit previously created surgeon template sets, return to the HomeScreen, access the Help Manual, and view treatment activation status.

From the Manage Templates Screen for administrators or general users,selecting a surgeon name and pressing the EDIT button 208 causes theSurgeon Template Screen (such as shown in FIG. 14 ) for that surgeon tobe displayed. From the Surgeon Template Screen, the administrator/usercan create templates for the desired treatment(s) and edit previouslycreated templates, set default parameters, go to the Home Screen orAdministrator Home Screen, return to the Manage Templates Screen, accessthe Help Manual, and view treatment activation status.

From the Administrator Home Screen, pressing the SETTINGS button 210causes the Settings Screen to be displayed. From the Settings Screen,the administrator can select the user language and country for softwarelocalization, adjust the touchscreen drag sensitivity, enable anddisable graphic reports, enable and disable the network connection,return to the Administrator Home Screen, access the Help Manual, andview treatment activation status.

There are three main types of planning screens, all of which have asimilar appearance but perform different functions. Default DetailsScreens allow a person to set default treatment parameters, which carryover to the Surgeon Template and Treatment Planning Screens. SurgeonTemplate Screens allow a person to create templates with presettreatment parameters, which can be recalled from the Treatment PlanningScreens. Treatment Planning Screens allow a person to create anindividual treatment plan for a given patient.

When a parameter field on a planning screen is selected by touching, aninput keypad displays on the screen. The range of allowable settings isdisplayed at the top of the keypad. If a value outside of the displayedrange is entered, an “out of range” error is displayed.

If a parameter value is entered that differs from the default value forany treatment parameter, an asterisk displays to the left of thetreatment parameter value and a “return-to-default” button displays tothe right. Pressing the “return-to-default” button causes the treatmentparameter value to revert to the default value displayed on the“return-to-default” button.

From the Surgeon Template Screen for the selected surgeon, pressing theDEFAULT DETAILS button 212 for the desired treatment causes thecorresponding Default Details Screen to be displayed. The desireddefault parameter values can then be entered. FIG. shows an exampleCapsulotomy Default Details Screen used to specify default parametervalues used to form a capsulotomy incision in the anterior portion ofthe lens capsule. FIG. 16 shows an example Lens Fragmentation DefaultDetails Screen used to specify default parameter values used to formincisions in the lens to fragment the lens. FIG. 17 shows an ArcuateIncisions Default Details Screen used to specify default parametervalues used to form an arcuate incision in the cornea. FIG. 18 shows aCataract Incisions Primary Geometric Default Details Screen used tospecify default parameter values used to form access incision in thecornea for primary cataract surgical instruments (e.g., an instrumentused to insert an IOL following removal of the fragmented crystallinelens nucleus). FIG. 19 shows a Cataract Incisions Sideport(s) GeometricDefault Details Screen used to specify default parameter values used toform access incision in the cornea for sideport cataract surgicalinstruments (e.g., a cataract instrument that is not used to insert anIOL following removal of the fragmented crystalline lens nucleus). FIG.20 shows a Cataract Incisions Primary Laser Default Details Screen usedto specify default parameter values related to controlling the energyand placement of the laser pulse focus points used to create primarycataract incision in the cornea. FIG. 21 shows a Cataract IncisionsSideport(s) Laser Default Details Screen used to specify defaultparameter values related to controlling the energy and placement of thelaser pulse focus points used to create sideport cataract incisions inthe cornea. The “line density” parameters 214 control the amount ofoverlap between adjacent lines of laser pulse locations—a density of 1.0or less results in no overlap and a density greater than 1.0 can be usedto specify corresponding increasing levels of overlap. The GUI providesthe ability to independently control aspects of the incision in ananterior portion of the cornea, in a posterior portion of the cornea,and between the anterior and posterior portions of the cornea. AnAnterior Line Distance parameter 216 is used to specify a depth as apercentage of the thickness of the cornea that controls the depth in thecornea above which the anterior line density parameter applies and belowwhich the central line density parameter applies. Similarly, thePosterior Line Distance parameter 218 is used to specify a depth as apercentage of the thickness of the cornea that controls the depth in thecornea above which the central line density parameter applies and belowwhich the posterior line density parameter applies. The horizontal spotspacing parameter 220 controls the horizontal spacing between laserpulse focus locations. The vertical spot spacing parameter 222 controlsthe vertical spacing between laser pulse focus locations. And the pulseenergy parameter 224 controls the pulse energy of the laser pulses.Pressing the BACK button 226 returns to the Surgeon Template Screen.

The values entered in the Default Details Screens carry over to theSurgeon Template and Treatment Planning Screens. If a user selects avalue other than the default value for any parameter on a SurgeonTemplate or Treatment Planning Screen, an asterisk displays to the leftof the value and a “return-to-default” button displays to the right.

From the Surgeon Template Screen for the selected surgeon, pressingthe + (create template) tab 228 for the desired treatment causes thecorresponding Template Screen to be displayed. The template name that isentered in the NAME field 229 on this screen will display in a drop-downlist on the Treatment Planning Screen for the selected treatment.Pressing the COPY button 230 is used to create a copy of the template.Pressing the X button 231 is used to delete the template. Pressing theDETAILS 234 button returns to the Template Details Screen. FIG. 22 showsan example capsulotomy (basic) template screen. FIG. 23 shows an examplecapsulotomy template details screen. Pressing the BACK button 226returns to the Surgeon Template Screen. FIG. 24 shows an example lensfragmentation (basic) template screen. FIG. 25 shows an example lensfragmentation template details screen. FIG. 26 shows an example cataractincisions (basic) template screen. FIG. 27 shows an example cataractincision primary geometric template details screen. FIG. 28 shows anexample cataract incisions sideport(s) geometric template detailsscreen. FIG. 29 shows an example cataract incisions primary lasertemplate details screen. FIG. 30 shows an example cataract incisionssideport(s) laser template details screen.

Pressing the + (create treatment plan) tab 232 on the Home Screen isused to access a Plan a Treatment Screen, an example of which is shownin FIG. 31 . From the Plan a Treatment Screen, basic treatmentinformation can be entered, and navigation to other screens can beaccomplished. Treatment settings can be selected prior to coupling thepatient's eye to the patient interface 52. All treatment parameters canbe verified before proceeding with the treatment.

In many embodiments, the following information must be entered on thePlan a Treatment Screen before proceeding with treatment planning:surgeon name 235, patient first and last name 236, 283, patient ID 240(optional), patient date of birth 242, treatment eye 244, and selectedincision(s) 246. After entering the required information, pressing theNEXT button 248 is used to proceed to the treatment parameter selectionscreens.

FIG. 32 shows a Capsulotomy (Basic) Screen used to select basictreatment parameter values for a capsulotomy incision. The Capsulotomy(Basic) Screen can be accessed in any of the following ways: pressingthe NEXT button 248 on the Plan a Treatment Screen; pressing the BASICbutton 250 on the Capsulotomy Details Screen; pressing the BACK button226 on the (Basic) Screen for the next treatment in the sequence; andselecting the Quick Navigation Bar Capsulotomy Icon on the Plan aTreatment Screen, the Lens Fragmentation, Arcuate Incisions, or CataractIncisions (Basic) Screen; or the Treatment Summary Screen. From theCapsulotomy (Basic) Screen, a person can select the followingparameters:

-   -   Template Name 252    -   Pattern 254: “Circular” is currently the only pattern option        although others can be implemented    -   Diameter 256: capsulotomy circular opening diameter    -   Center Method 258:        -   “Pupil” uses the identified pupil to center the capsulotomy.        -   “Limbus” uses the identified limbus to center the            capsulotomy.        -   “Scanned Capsule” uses the data from the ranging subsystem            46 for the anterior and posterior lens surfaces, and the            line connecting the centers of the spheres fitted to these            surfaces, to center the capsulotomy.        -   “Custom” allows a user to drag the touchscreen image to the            desired location within the safety zone when in the            treatment screens. Dragging is not available during            capsulotomy planning.        -   “Maximized” uses the identified pupil to center the            capsulotomy and to maximize the capsulotomy diameter.

Once valid settings have been selected, the selected diameter 260displays in the center of an eye model 262, as shown in FIG. 32 . Theplanning screens typically shown an anterior view of the eye modeland/or a cross-sectional view of the eye model. Details of the selectedincisions are typically shown on the eye model so as to provide the userwith a visual representation of the selected treatment parameterrelative to a representation of an eye. Pressing the DETAILS button 234proceeds to the Capsulotomy Details Screen, an example of which is shownin FIG. 33 . Pressing the BACK button 226 returns to the Plan aTreatment Screen. Pressing the NEXT button 248 proceeds to the (Basic)Screen for the next treatment in the sequence. If, however, the onlytreatment selected on the Plan a Treatment Screen is the capsulotomytreatment, pressing the NEXT button 248 on the Capsulotomy (Basic)Screen will return directly to the Treatment Plan Summary Screen. If theHOME button 264 on the Capsulotomy (Basic) Screen is pressed, thecurrent treatment parameters will be saved.

The Capsulotomy Details Screen is used to specify detail parametervalues for the capsulotomy incision. To access the Capsulotomy DetailsScreen, the DETAILS button 234 is pressed on the Capsulotomy (Basic)Screen or the Quick Navigation Bar Capsulotomy Icon on the LensFragmentation, Arcuate Incisions, or Cataract Incisions Primary orSideport(s) Details Screen.

From the Capsulotomy Details Screen, a user can select incision depth266, horizontal spot spacing 268, vertical spot spacing 270, and pulseenergy 272. The incision depth 266 is the axial extent of thecapsulotomy cylinder pattern centered on the detected lens anteriorsurface. The horizontal spot spacing 268 is the lateral spot-to-spotspacing. The vertical spot spacing 270 is the axial spot-to-spotspacing. And the pulse energy 272 is the energy delivered per pulse.FIG. 34 shows an entry key pad 273 that displays for entering incisiondepth upon selecting incision depth from the Capsulotomy Details Screen.If a parameter value is entered that is outside an acceptable range, an“out of range” error 274 displays as shown in FIG. 34 . Once validsettings have been chosen, the incision depth 276 is displayed in thelower eye model 277, as shown in FIG. 34 . Pressing the BASIC button 250returns to the Capsulotomy (Basic) Screen. Then, pressing the BACKbutton 226 returns to the Plan a Treatment Screen. Alternatively,pressing the NEXT button 248 proceeds to the (Basic) Screen for the nexttreatment in the sequence. If, however, the only treatment selected onthe Plan a Treatment Screen is the capsulotomy treatment, pressing theNEXT button 248 on the Capsulotomy (Basic) Screen will return directlyto the Treatment Plan Summary Screen. If the HOME button 264 on theCapsulotomy (Basic) Screen is pressed, the current treatment parameterswill be saved.

The Lens Fragmentation (Basic) Screen (an example of which is shown inFIG. is used to control the fragmentation of the crystalline lensnucleus. The Lens Fragmentation (Basic) Screen can be accessed in any ofthe following ways:

-   -   Press the NEXT button 248 on the Capsulotomy (Basic) or Details        Screen (if the user selected the capsulotomy treatment) or on        the Plan a Treatment Screen (if the user did not select the        capsulotomy treatment).    -   Press the BASIC button 250 on the Lens Fragmentation Details        Screen.    -   Select Quick Navigation Bar Lens Fragmentation Icon on the Plan        a Treatment Screen; the Capsulotomy, Arcuate Incisions, or        Cataract Incisions (Basic) Screen; or the Treatment Summary        Screen.

From the Lens Fragmentation (Basic) Screen, a user can select thefollowing parameters:

-   -   Template Name 278    -   Segmentation 280: lens fragmentation pattern, with or without        softening        -   Lens softening adds cross-hatch patterns to the spaces            between the lens segments defined in the pattern type            selection.    -   Diagnostic central lens thickness 282 (optional): thickness of        diagnostic lens

Once valid settings have been chosen, the selected fragmentation pattern284 displays in the center of the eye model 285, as shown in FIG. 35 .Pressing the DETAILS button 234 proceeds to the Lens FragmentationDetails Screen, an example of which is shown in FIG. 36 . Pressing theBACK button 226 returns to the Capsulotomy (Basic) Screen. Pressing theNEXT button 248 proceeds to the Treatment Plan Summary Screen or to the(Basic) Screen for the next treatment in the sequence.

The Lens Fragmentation Details Screen is used to specify detailedparameter values used to control the fragmentation of the lens. Toaccess the Lens Fragmentation Details Screen, the DETAILS button 234 ispressed on the Lens Fragmentation (Basic) Screen or the Quick NavigationBar Lens Fragmentation icon on the Capsulotomy, Arcuate Incisions, orCataract Incisions Primary or Sideport(s) Details Screen is pressed.From the Lens Fragmentation Details Screen, a user can select thefollowing parameters:

-   -   Seg-Soft Spacing 286: distance between segmentation lines and        initial softening cross-hatch pattern lines    -   Grid Spacing 288: distance between successive softening        cross-hatch pattern lines    -   Diameter 290 (Maximized or Limited): diameter for maximum        allowed lens fragmentation pattern; if maximized is selected,        diameter is given by the detected iris; if limited is selected,        size will be given by the smaller of either the detected iris or        the limited diameter specified    -   Segmentation Repetitions 292: number of times the treatment        laser passes over the pattern    -   Horizontal Spot Spacing 294: lateral spot-to-spot spacing    -   Vertical Spot Spacing 296: axial spot-to-spot spacing    -   Anterior/Posterior Capsule Safety Margin 298: safety distances        between lens fragmentation incisions and anterior/posterior        capsule surfaces    -   Anterior/Posterior Pulse Energy 300: system varies pulse energy        between these values as pattern is delivered, moving from        posterior to anterior

Similar to other screens of the GUI, parameter values can be entered bypressing the corresponding portion of the touch-screen control panel 12.Once valid settings have been chosen, anterior and posterior safetyzones 302 are displayed in the lower eye model 304, as shown in FIG. 36. Pressing the BASIC button returns to the Lens Fragmentation (Basic)Screen. Pressing the BACK button 226 returns to the (Basic) Screen forthe previous treatment in the sequence. Pressing the NEXT button 248proceeds to the (Basic) Screen for the next treatment in the sequence.

FIG. 37 shows the Arcuate Incisions (Basic) Screen. The ArcuateIncisions (Basic) Screen is used to control the formation of one or morearcuate incisions in the cornea. The Arcuate Incisions (Basic) Screencan be accessed in any of the following ways:

-   -   Pressing the NEXT button 248 on the Lens Fragmentation (Basic)        or Details Screen (if the lens fragmentation procedure was        selected), on the Capsulotomy (Basic) or Details screen (if the        capsulotomy procedure was selected and the lens fragmentation        procedure was not selected), or on the Plan a Treatment Screen        (if neither of the capsulotomy or lens fragmentation procedures        were selected).    -   Pressing the (BASIC) button 250 on the Arcuate Incisions Details        Screen.    -   Selecting the Quick Navigation Bar Arcuate Incisions Icon on the        Plan a Treatment Screen; the Capsulotomy, Lens Fragmentation, or        Cataract Incisions (Basic) Screen; or the Treatment Summary        Screen.

From the Arcuate Incisions (Basic) Screen, a user can select thefollowing parameters:

-   -   Type 306: Single, Symmetric, or Asymmetric    -   Axis 308    -   Optical Zone 310: twice the radius from the lateral center of        the eye (as determined with the user-selected centering method)        to the cornea anterior penetrating point of the arcuate        incision. In the case of intrastromal arcuate incisions, the        optical zone is twice the radius from the center of the eye to        the point where the incision would intersect the cornea anterior        if the incision were extended.    -   Length 312: length of the incision(s)    -   Center Method 314:        -   “Pupil” uses the identified pupil to center the incision.        -   “Limbus” uses the identified limbus to center the incision.        -   “Custom” allows the user to drag the touchscreen image to            the desired location within the safety zone when in the            treatment screens. Dragging is not available during arcuate            incision planning.

Once valid settings have been chosen, the selected arcuate incisionspattern 316 displays in the center of the eye model 317, as shown inFIG. 37 . Pressing the DETAILS button 234 proceeds to the ArcuateIncisions Details Screen, an example of which is shown in FIG. 34 .Pressing the BACK button 226 returns to the (Basic) Screen for theprevious procedure in the sequence. Pressing the NEXT button 248proceeds to the (Basic) Screen for the next procedure in the sequence.

To access the Arcuate Incisions Details Screen (example shown in FIG. 38), the DETAILS button 234 on the Arcuate Incisions (Basic) Screen ispressed or the Quick Navigation Bar Arcuate Incisions Icon on theCapsulotomy, Lens Fragmentation, or Cataract Incisions Primary orSideport(s) Details Screen is pressed. From the Arcuate IncisionsDetails Screen, a user can select the following parameters:

-   -   Penetration Type 318: Anterior Penetrating or Intrastromal    -   Depth Unit 320: Percent or Microns    -   Uncut Anterior/Posterior Percentage 322    -   Side Cut Angle 324: angle at which incision is made to cornea    -   Horizontal Spot Spacing 326: lateral spot-to-spot spacing    -   Vertical Spot Spacing 328: axial spot-to-spot spacing    -   Pulse Energy 330: energy delivered per pulse    -   Anterior/Central Line Density 332    -   Anterior Line Distance 334

Once valid settings have been chosen, the side cut angle 336 and uncutanterior and posterior percentages are displayed in the lower eye model338, as shown in FIG. 38 . Pressing the BASIC button returns to theArcuate Incisions (Basic) Screen. Pressing the BACK button 226 returnsto the (Basic) Screen for the previous procedure in the sequence.Pressing the NEXT button 248 proceeds to the (Basic) Screen for the nextprocedure in the sequence.

FIG. 39 shows an example of a Cataract Incisions (Basic) Screen. TheCataract Incisions (Basic) Screen is used to control the formation ofaccess incisions in the cornea through which cataract surgicalinstruments are inserted to gain access to remove the fragmentedcrystalline lens nucleus. The Cataract Incisions (Basic) Screen can beaccessed in any of the following ways:

-   -   By pressing the NEXT button 248 on the Arcuate Incisions (Basic)        or Details Screen (if the arcuate incisions procedure has been        selected), on the Lens Fragmentation (Basic) or Details Screen        (if the lens fragmentation procedure has been selected and the        arcuate incisions procedure has not been selected), on the        Capsulotomy (Basic) or Details screen (if the capsulotomy        procedure has been selected and but the lens fragmentation or        arcuate incisions procedure has not been selected), or on the        Plan a Treatment Screen (if the capsulotomy, lens fragmentation,        or arcuate incisions procedure has not been selected).    -   By press the BASIC button 250 on any of the Cataract Incisions        Details Screens.    -   By select the Quick Navigation Bar Cataract Incisions Icon on        the Plan a Treatment Screen; the Capsulotomy, Lens        Fragmentation, or Arcuate Incisions (Basic) Screen; or the        Treatment Summary Screen.

From the Cataract Incisions (Basic) Screen, a user can select thefollowing parameters:

-   -   Template Name 340    -   Number of Primary Incisions 342 (1 or 2)    -   Number of Sideport Incisions 344 (0 to 5)    -   Axis of Primary/Sideport Incision(s) 346    -   Limbus Offset of Primary/Sideport Incision(s) 348    -   Width of Primary/Sideport Incision(s) 350: width of the cut from        an en face view    -   Length of Primary/Sideport Incision(s) 352: length of the cut        from an en face view

Once valid settings have been chosen, the selected cataract incisionpattern 354 displays in the center of the eye model 356, as shown inFIG. 39 . Pressing the DETAILS button 234 proceeds to the CataractIncisions Primary Geometric Details Screen, an example of which is shownin FIG. 40 . Pressing the BACK button 226 returns to the (Basic) Screenfor the previous procedure in the sequence. Pressing the NEXT button 248proceeds to the Treatment Plan Summary Screen.

To access the Cataract Incisions Primary Geometric Details Screens, theDETAILS button 234 on the Cataract Incisions (Basic) Screen is pressedor the Quick Navigation Bar Cataract Incisions Icon on the Capsulotomy,Lens Fragmentation, or Arcuate Incisions Details Screen is selected.From the Cataract Incisions Primary Geometric Details Screen, a personcan select the following parameters:

-   -   Uncut Region 358: Anterior, Central, Posterior, or None    -   Depth Unit 360: Percent or Microns    -   Uncut Anterior/Posterior Percentage 362    -   Uncut Central Length 364    -   Anterior/Posterior Plane Depth 366    -   Anterior/Posterior Side Cut Angle 368

Once valid settings have been chosen, the anterior and posterior sidecut angles and uncut central length 370 are displayed in the lower eyemodel 372, as shown in FIG. 40 . Pressing the

button 374 proceeds to the Cataract Incisions Sideport(s) GeometricDetails Screen, an example of which is shown in FIG. 41 . Pressing theBASIC button 250 returns to the Cataract Incisions (Basic) Screen.Pressing the BACK button 226 returns to the (Basic) Screen for theprevious procedure in the sequence. Pressing the NEXT button 248proceeds to the Treatment Plan Summary Screen.

To access the Cataract Incisions Sideport(s) Geometric Details Screens,the

button 374 on the Cataract Incisions Primary Geometric Details Screen orthe

button 376 on the Cataract Incisions Primary Laser Details Screen ispressed. From the Cataract Incisions Sideport(s) Geometric DetailsScreen, a person can select the following parameters:

-   -   Uncut Type 378: Anterior, Central, Posterior, or None    -   Depth Unit 380: Percent or Microns    -   Uncut Anterior/Posterior Percentage 382    -   Uncut Central Length 384    -   Anterior/Posterior Plane Depth 386    -   Anterior/Posterior Side Cut Angle 388

Once valid settings have been chosen, the anterior and posterior sidecut angles and uncut central length 390 are displayed in the lower eyemodel 392, as shown in FIG. 41 . Pressing the

button 374 proceeds to Cataract Incisions Primary Laser Details Screen,an example of which is shown in FIG. 42 . Pressing the

button 376 returns to the Cataract Incisions Primary Geometric DetailsScreen. Pressing the BASIC button 250 returns to the Cataract Incisions(Basic) Screen. Pressing the BACK button 226 returns to the (Basic)Screen for the previous procedure in the sequence. Pressing the NEXTbutton 248 proceeds to the Treatment Plan Summary Screen.

To access the Cataract Incisions Primary Laser Details Screens, the

button 374 on the Cataract Incisions Sideport(s) Geometric DetailsScreen or the

button 376 on the Cataract Incisions Sideport(s) Laser Details Screen ispressed. From the Cataract Incisions Primary Laser Details Screen, aperson can select the following parameters:

-   -   Anterior/Central/Posterior Line Density 394    -   Anterior/Posterior Line Distance 396    -   Horizontal Spot Spacing 398: lateral spot-to-spot spacing    -   Vertical Spot Spacing 400: axial spot-to-spot spacing    -   Pulse Energy 402: energy delivered per pulse

Pressing the

button 374 proceeds to Cataract Incisions Sideport(s) Laser DetailsScreen, an example of which is shown in FIG. 43 . Pressing the

button 376 returns to the Cataract Incisions Sideport(s) GeometricDetails Screen. Pressing the BASIC button 250 returns to the CataractIncisions (Basic) Screen. Pressing the BACK button 226 returns to the(Basic) Screen for the previous procedure in the sequence. Pressing theNEXT button 248 proceeds to the Treatment Plan Summary Screen.

To access the Cataract Incisions Sideport(s) Laser Details Screens, the

button 374 on the Cataract Incisions Primary Laser Details Screen ispressed. From the Cataract Incisions Sideport(s) Laser Details Screen, aperson can select the following parameters:

-   -   Anterior/Central/Posterior Line Density 404    -   Anterior/Posterior Line Distance 406    -   Horizontal Spot Spacing 408: lateral spot-to-spot spacing    -   Vertical Spot Spacing 410: axial spot-to-spot spacing    -   Pulse Energy 412: energy delivered per pulse

Pressing the

button 376 returns to the Cataract Incisions Primary Laser DetailsScreen. Pressing the BASIC button 250 returns to the Cataract Incisions(Basic) Screen. Pressing the BACK button returns 226 to the (Basic)Screen for the previous procedure in the sequence. Pressing the NEXTbutton 248 proceeds to the Treatment Plan Summary Screen.

After the desired treatment parameters have been selected, pressing theNEXT button 248 on the (Basic) or Details Screen for the last treatmentin the sequence or pressing the Quick Navigation Bar Treatment SummaryIcon on the Patient Info, Capsulotomy, Lens Fragmentation, ArcuateIncisions or Cataract Incisions Screen proceeds to the Treatment PlanSummary Screen, an example of which is shown in FIG. 44 . The TreatmentPlan Summary Screen provides an overview of the current treatment plan,including a graphical representation 414 of the selected treatmentparameters.

After verifying the treatment plan summary, pressing the HOME button 416returns to the Home Screen. To make changes to the treatment plan,pressing the BACK button 226 returns to the (Basic) Screen for the lasttreatment in the sequence, or pressing the Quick Navigation Bar icon forthe desired treatment returns to the (Basic) Screen for that treatment.

FIG. 45 shows an example Surgical Timeout Screen. After selecting atreatment plan from the Home Screen and pressing the SURGICAL TIMEOUTbutton 418 on the Treatment Summary Screen, the Surgical Timeout Screendisplays. The Surgical Timeout Screen provides a opportunity to verifythat the patient details and treatment parameters are correct. Afterverifying that the patient details and treatment parameters are correct,pressing the APPROVE button 420 proceeds to patient docking screens. Ifany information on the Surgical Timeout Screen is incorrect, pressingthe Home button returns to the Home Screen. Alternatively, the BACK TOPLANNING 422 button can be pressed to edit the Treatment Plan.

In many embodiments, the laser eye surgery system 2 is configured torequire authorization for a treatment before performing the treatment.In many embodiments, the patient interface 52 includes single usecomponents that are replaced prior to each treatment. Such single usecomponents can include an RFID activation tag that is scanned via asuitable RFID reader, such as the patient interface radio frequencyidentification (RFID) reader 20. Other suitable known activationapproaches can also be used, such as known activation approaches usingnetwork communication. The activation tag included with the single usepatient interface components can be scanned before enabling proceedingto the patient docking screens. If the activation tag has not beenscanned, “Scan to Activate” 424 displays at the top of the screen andthe APPROVE button 420 is disabled, as shown in FIG. 46 .

After verifying the information on the Surgical Timeout Screen, scanningthe activation tag included with the single use patient interfacecomponents, and pressing the APPROVE button 420, the patient dockingscreens guide the user through the patient docking procedure. Thepatient docking screens, an example of which is shown in FIG. 47 ,display live video of the patient's eye 426 on the left side of thescreen and display prompts for each step of the docking process withinstructions on the right side of the screen. Also displayed on the leftside of the screen, overlaid on top of the video, are three indicatorsthat are used to aid in the docking process. The arrow and acceptablevertical zone 428 on the right side of the video indicate the verticalposition of the patient chair and when it is in the correct range forcertain steps of the docking process. The line centered on top of thevideo and the different colored zones 430, which change depending on thecurrent step of the docking process, indicate the horizontal forcesbeing exerted on the disposable lens. The arrow on the left of the videoand the different colored zones 432, which change depending on thecurrent step of the docking process, indicate the vertical forces beingexerted on the disposable lens.

When the initial patient docking screen displays, the Disposable Lenspanel 434 is open, as shown in FIG. 48 . As indicated in the DisposableLens panel 434, the user is prompted to install a new disposable lens onthe system if not already installed. If the system detects that thedisposable lens has not been replaced from a previous treatment, theuser will be prompted to remove the old disposable lens and install anew disposable lens, as shown in FIG. 49 .

As shown in FIG. 50 , when the system detects that a new disposable lenshas been properly installed, a check mark displays in the DisposableLens panel 434, and the Vacuum panel 436 opens. After the systemverifies installation of the disposable lens, the Vacuum panel 436opens. The open Vacuum panel 436 includes instructions to the user toplace and center the suction ring of the patient interface 52 on thepatient's eye, and then apply patient vacuum. In many embodiments, anaudio sound will play repeatedly while the system is attempting to applyvacuum and a success or failure sound will alert the user if theapplication of vacuum has succeeded or failed.

As shown in FIG. 51 , when the system detects that the suction ring hasbeen placed and patient vacuum applied, a check mark displays in theVacuum panel 436, and the Capture panel 438 opens. The open Capturepanel 438 includes instructions to rotate the surgical chair to thetreatment position and use the joystick to raise the chair until theindicator arrow 440 on the right is within the Capture Zone 442. Theindicator arrow corresponds to the position of the chair and must bewithin the green Capture Zone in order to enable the CAPTURE button. InFIG. 51 , the indicator arrow 440 is outside the Capture Zone 442 andindicates that the patient chair must be raised to place the indicatorarrow 440 within the Capture Zone 442 so as to engage the suction ringto the disposable lens. FIG. 52 shows the indicator arrow 440 within theCapture Zone 442 and engagement between the suction ring and thedisposable lens.

When the indicator arrow 440 on the right side of the video is withinthe Capture Zone 442, pressing the CAPTURE button activates vacuum tocapture the suction ring in the disposable lens. When the system detectsthat the suction ring has been captured, a check mark displays in theCapture panel 438, and the Lock panel 444 opens, as shown in FIG. 53 .An audio sound will play repeatedly while the system is attempting tocapture the suction ring and a success or failure sound will alert theuser if the capture has succeeded or failed. The open Lock panel 444displays instructions to use the patient chair joystick 38 to adjust thesurgical chair until all three indicators 446, 448, 450 (i.e., thevertical green bar on the left, circular green area over the video, andvertical green bar on the right) are within their respective Lock Zones452, 454, 456, as shown in FIG. 54 .

When the white indicator arrows 446, 448, 450 are within the Lock Zones452, 454, 456 they will turn green, indicating that the Lock buttonshould be pressed. Pressing the lock button activates a lockingmechanism in the patient interface 52 that fixes the vertical positionof the suction ring relative to the system. When the system detects thatthe lock has been secured, a check mark displays in the Lock panel 444,and the Verify Fluid panel 458 opens, as shown in FIG. 55 . When thedisposable lens, vacuum, capture, and lock steps have all beencompleted, the horizontal and vertical force indicators (indicator tothe left of the video and in the center of the video) will minimize tothe upper left corner of the video for the rest of the treatmentprocess. The Verify Fluid panel 458 displays instructions to check thevideo image 426 of the patient's eye to ensure that the suction ring iscompletely filled with sterile buffered saline solution and that no airbubbles are present. The video image 426 should appear sharp and clearwhen the suction ring is completely filled with sterile buffered salinesolution and no air bubbles are present.

After verifying that the video image 426 of the patient's eye is sharpand clear, the FLUID CONFIRMED button 460 is pressed to initiatescanning of the eye by the ranging subsystem 46. A check mark willappear next to the Verify Fluid panel 458 after pressing the FLUIDCONFIRMED button 460. The force indicators will also change from onlyshowing a red band, to showing yellow, orange and red bands, indicatingdifferent severity levels of forces being exerted by the patient on thedisposable lens. In summary, after capturing and locking the patient;verifying that the video image 426 of the eye is sharp and clear; andpressing the FLUID CONFIRMED button 460 on the final Docking Screen, anArcuate/Cataract Incisions Adjustment Screen or Lens Group AdjustmentScreen displays, and scanning of the eye 43 by the ranging subsystem 46begins automatically.

If arcuate and/or cataract incisions have been selected, theArcuate/Cataract Incisions Adjustment Screen, as shown in FIG. 56 ,displays after pressing the FLUID CONFIRMED button 460 on the finalDocking Screen. From the Arcuate/Cataract Incisions Adjustment Screen,the user can:

-   -   Monitor the progress of scanning of the eye by the ranging        subsystem 46    -   Stop scanning of the eye by the ranging subsystem 46    -   Rescan the eye with the ranging subsystem 46    -   View a graphical display of selected treatment parameters    -   Change the Arcuate Incisions Center Method    -   Change the Cyclorotation Compensation    -   Navigate to the Adjust Arcuate Incisions and Adjust Cataract        Incisions Screens to adjust treatment parameters    -   Accept the scan and proceed to the Lens Group Adjustment Screen        (if the user selected capsulotomy or lens fragmentation) or the        Integral Guidance® Summary Screen (if the user did not select        capsulotomy or lens fragmentation)

When scanning of the eye by the ranging subsystem 46 is complete,“Integral Guidance® Complete” displays on the screen. If desired, thetreatment parameters can be adjusted and the eye can be re-scanned. Whensatisfied with the scan of the eye 43 by the ranging subsystem 46,pressing the NEXT button 248 proceeds to the Lens Group Adjustment orScanning Summary Screen.

If custom arcuate incisions center method is selected, as shown in FIG.57 , the user can use the touchscreen 12 to drag and move the center ofthe arcuate incisions. Cyclorotation compensation adjustments areavailable for all corneal incisions, with the same cyclorotationcompensation angle applied to all corneal incisions in a given treatmentplan. The cyclorotation compensation adjustment can be selected aseither suction ring position based or manually adjusted by the user. Forsuction ring-based cyclorotation compensation, the rotation angle of thepatient suction ring is detected and used as the cyclorotationcompensation angle. If the custom cyclorotation compensation method isselected, the cyclorotation compensation angle can be adjusted withinthe range of −45° to +45°. For example, the user can touch and drag theorientation indicators to adjust the cyclorotation compensation angle toa desired angle, such as from the orientation shown in FIG. 57 to theorientation shown in FIG. 58 .

To adjust the arcuate incisions parameters after the scanning of the eye43 by the ranging subsystem 46, pressing the

or

button 462 on the Arcuate/Cataract Incisions Adjustment Screen proceedsto the Adjust Arcuate Incisions (Basic) Screen, an example of which isshown in FIG. 59 . The user can selectively adjust the parameters on theAdjust Arcuate Incisions (Basic) Screen, and then press the DETAILSbutton 234 to proceed to the Adjust Arcuate Incisions Details Screen, anexample of which is shown in FIG. 60 , or the DONE button 464 to returnto the Arcuate/Cataract Incisions Adjustment Screen. The user canselectively adjust parameters on the Adjust Arcuate Incisions DetailsScreen, and then press the BASIC button 250 to return to the AdjustArcuate Incisions (Basic) Screen or the

or

button 466, 468 to proceed to the Adjust Cataract Incisions (Basic)Screen.

To adjust the cataract incisions parameters after the scanning of theeye 43 by the ranging subsystem 4, pressing the

or

button on the Arcuate/Cataract Incisions Adjustment Screen or AdjustArcuate Incisions (Basic) or Details Screen proceeds to the AdjustCataract Incisions (Basic) Screen. The

icons represent the primary incisions, and the

icons represent the sideport incisions. The number of icons displayeddepends on the number of primary and sideport incisions selected on theCataract Incisions (Basic) Screen. The user may press any

or

icon to proceed to the Adjust Cataract Incisions (Basic) Screen. Theimage displayed in orange in the eye model on the left of the AdjustCataract Incisions (Basic) Screen, however, depends on which icon isselected. In FIG. 61 , the primary incision icon 466 is selected, andthe image 470 highlighted in the eye model represents the primaryincision. The user can selectively adjust the parameters on the AdjustCataract Incisions (Basic) Screen, and then press the DETAILS button 234to proceed to the Cataract Incisions Adjust Primary Geometric DetailsScreen, an example of which is shown in FIG. 62 , or the DONE button 464to return to the Arcuate/Cataract Incisions Adjustment Screen.

After selectively adjusting parameters on the Cataract Incisions AdjustPrimary Geometric Details Screen, the user can press the

button 374 to go to the Cataract Incisions Adjust Sideport(s) GeometricDetails Screen, an example of which is shown in FIG. 63 , or the BASICbutton 250 to return to the Adjust Cataract Incisions (Basic) Screen.

After selectively adjusting parameters on the Cataract Incisions AdjustSideport(s) Geometric Details Screen, the user can press the

button 374 to go to the Cataract Incisions Adjust Primary Laser DetailsScreen, an example of which is shown in FIG. 64 , the

button 376 to go to the Cataract Incisions Adjust Primary GeometricDetails Screen, or the BASIC button 250 to return to the Adjust CataractIncisions (Basic) Screen.

After selectively adjusting parameters on the Cataract Incisions AdjustPrimary Laser Details Screen, the user can press the

button 374 to go to the Cataract Incisions Adjust Sideport(s) LaserDetails Screen, an example of which is shown in FIG. 65 , the

button 376 to go to the Cataract Incisions Adjust Sideport(s) GeometricDetails Screen, or the BASIC button 250 to return to the Adjust CataractIncisions (Basic) Screen. After selectively adjusting parameters on theCataract Incisions Adjust Sideport(s) Laser Details Screen, the user canpress the

button 376 to go to the Cataract Incisions Adjust Primary Laser DetailsScreen or the BASIC button 250 to return to the Adjust CataractIncisions (Basic) Screen.

After selectively adjusting parameters on the Adjust Arcuate Incisionsand Adjust Cataract Incisions Screens and pressing the NEXT button 248on the Arcuate/Cataract Incisions Adjustment Screen, the Lens GroupAdjustment Screen displays, examples of which is shown in FIGS. 66 and67 . The user can also access the Lens Group Adjustment Screen bypressing the Quick Navigation Bar Lens Group Adjustment Screen Icon.From the Lens Group Adjustment Screen, the user can:

-   -   Monitor the progress of scanning of the eye by the ranging        subsystem 46    -   Stop scanning of the eye by the ranging subsystem 46    -   Rescan the eye with the ranging subsystem 46    -   View a graphical display of selected treatment parameters    -   Change the center method    -   Maximize the capsulotomy diameter (automatically centers on        pupil)    -   Navigate to the Adjust Capsulotomy and Adjust Lens Fragmentation        Screens to adjust treatment parameters    -   Navigate to the Arcuate/Cataract Incisions Adjustment Screen    -   Accept the scan and proceed to the Integral Guidance® Summary        Screen

If custom center method is selected, the user can use the touchscreen 12to drag and move the center of the capsulotomy. When dragging the centerof the capsulotomy, the area 472 (displayed in red in many embodiments)represents the capsulotomy iris safety zone. If the user drags thecapsulotomy outside of this boundary, the system will not allowtreatment. To move the center of the capsulotomy, the user touches nearthe center point and drags to move the custom center 474.

To selectively adjust the capsulotomy parameters after the scan of theeye 43 by the ranging subsystem 46, the user can press the

button 476 on the Lens Group Adjustment Screen to go to the AdjustCapsulotomy (Basic) Screen, an example of which is shown in FIG. 68 .Capsulotomy diameter can be adjusted by changing the value in theDiameter field 478 or by pressing and dragging the capsulotomy videooverlay 480. Dragging the overlay 480 away from the center 482 increasesthe diameter, and dragging the overlay 480 toward the center 482decreases the diameter, for example, from the diameter shown in FIG. 68to the diameter shown in FIG. 69 .

After selectively adjusting parameters on the Adjust Capsulotomy (Basic)Screen, the user can press the DETAILS button to proceed to the AdjustCapsulotomy Details Screen, an example of which is shown in FIG. 70 .The user can press the

button 484 to go to the Adjust Lens Fragmentation (Basic) Screen orpress the DONE button 464 to return to the Lens Group Adjustment Screen.After selectively adjusting parameters on the Adjust Capsulotomy DetailsScreen, the user can press the BASIC button 250 to return to the AdjustCapsulotomy (Basic) Screen or press the

button 484 to go to the Adjust Lens Fragmentation (Basic) Screen.

To adjust the lens fragmentation parameters after the scan of the eye 43by the ranging subsystem 46, the user can press the

button 484 on the Lens Group Adjustment Screen or Adjust Capsulotomy(Basic) Screen to go to the Adjust Lens Fragmentation (Basic) Screen, anexample of which is shown in FIG. 71 . After selectively adjustingparameters on the Adjust Lens Fragmentation (Basic) Screen, the user canpress the DETAILS button 234 to proceed to the Adjust Lens FragmentationDetails Screen, an example of which is shown in FIG. 72 . The user canpress the

button 476 to go to the Adjust Capsulotomy (Basic) Screen or press theDONE button 464 to return to the Lens Group Adjustment Screen. Afterselectively adjusting parameters on the Adjust Lens FragmentationDetails Screen, the user can press the BASIC button 250 to return to theAdjust Lens Fragmentation (Basic) Screen or press the

button 476 to go to the Adjust Capsulotomy (Basic) Screen.

When the results of the scan of the eye 43 by the ranging subsystem 46shown on the Lens Group Adjustment Screen are acceptable, the user canpress the NEXT button 248 to proceed to a Scanning Summary Screen, anexample of which is shown in FIG. 73 . The Scanning Summary Screendisplays a graphical representation 486 of the selected treatmentparameters, including circles representing the Pupil 488 and/or Limbus490 if either or both were used as the centering method for thecapsulotomy and arcuate incisions. The user can verify that thegraphical representation of all the optical surfaces (e.g., corneaanterior surface, cornea posterior surface, lens capsule anteriorsurface, lens capsule posterior surface, iris) identified by the lasereye surgery system 2 are accurate relative to the spatial disposition ofthe corresponding internal portions of the eye as located by the rangingsubsystem 46. The user can press the axial (left) image 492 or

button 494 to go to the Axial Zoom View Screen, an example of which isshown in FIG. 74 , or the sagittal (right) image or

button 496 to go to the Sagittal Zoom View Screen, an example of whichis shown in FIG. 75

The user can manually adjust identified surfaces by pressing the

button 498 to go to the Custom Fit Adjustment Screen, an example ofwhich is shown in FIG. 76 . From the Custom Fit Adjustment Screen, theuser can custom adjust the identified surfaces of the:

-   -   Cornea Anterior/Posterior 500    -   Lens Anterior/Posterior 502    -   Pupil 504    -   Limbus 506

On the Custom Fit Adjustment Screen the user can select between usingthe automatically detected ocular surfaces (“Auto”) and custom fittingthe ocular surfaces (“Custom”) by selecting the check mark

button under the desired column for each ocular surface. If customfitting has been selected, an additional button will appear to the rightof the check marks underneath the “Adjust Feature” column. Pressing theAdjust Feature button for a particular ocular surface will allow theuser to custom fit that ocular surface. Both the axial 508 and sagittal510 cross-section images of the scanned anterior portions of thepatient's eye 43 are shown in a split-screen view on the left of theexample Custom Fit Adjustment Screen. If none of the Adjust Featurebuttons are selected, the currently selected set (i.e., combination ofcustom and automatic fits for each surface) of ocular surfaces is shown.When selecting a surface to custom fit by pressing the Adjust Featurebutton for that surface, only that feature will be shown on the images.

When custom fitting the Cornea Anterior, Cornea Posterior, LensAnterior, or Lens Posterior surfaces, Slider Icons

512, 514 will also appear for custom fitting the surface, such as inFIG. 77 , which shows an example Custom Fit Cornea Anterior Screen. TheSlider Icons 512, 514 can be moved by touching and dragging the SliderIcons. Moving the middle slider on each image moves all three sliders onthat particular image. When moving the slider, the highlighted surfacedisappears to allow accurate positioning of each slider over the image.

Custom fitting of a particular ocular surface using the Slider Icons512, 514 can proceed in any suitable fashion. For example, the user canstart the custom fit by moving the middle sliders to the ocular surfaceof the respective scanned structure (e.g., cornea, lens capsule) of thepatient's eye 43 for both axial and sagittal images. Next, the user canmove the two side sliders to the surface for both images. When all sixsliders 512, 514 are on the ocular surface, custom fit for theparticular surface is complete. The process can be repeated if the fitis not satisfactory. To view all of the ocular surfaces again, theAdjust Feature button is de-selected.

When custom fitting is enabled for the Pupil and Limbus surfaces and therespective Adjust Feature button is selected, the image of the eye 516is shown from the anterior. To adjust this feature, the user can movethe selected area by pressing inside the marked area 518 and moving toan area of the user's choice. To increase or decrease the size of thecircle 518, the user can touch on or outside the circle 518 (FIG. 78shows an example Custom Fit Pupil Screen) and slide the user's fingeraway from or toward the center of the circle. To show both the Pupil andLimbus fits, the currently selected Adjust Feature button isde-selected.

After verifying that the graphical representation on the ScanningSummary Screen is accurate, the user can press the APPROVE button 420 toproceed to the Arcuate/Cataract Incisions Review Screen, an example ofwhich is shown in FIG. 79 . The user can verify that the graphicalrepresentations of the arcuate and/or cataract incisions (both theanterior 520 and cross-sectional 522 views) are accurate and representthe selected treatment plan. If desired, the user can press the BACKbutton 226 to return to the Scanning Summary Screen. Otherwise, the usercan press the APPROVE button 420 to proceed to the Final Review Screen,an example of which is shown in FIG. 80 .

The Final Review Screen allows the user to perform a final review oftreatment parameters before initiating laser treatment. If desired, theuser can press the BACK button 226 to return to the Arcuate/CataractIncisions Review Screen. Otherwise, the user can press the laserfootswitch 10 to initiate laser treatment.

After initiating laser treatment, the Treatment Progress Screen, anexample of which is shown in FIG. 81 , displays. Separate progress bars524 track the percentage treatment and time elapsed for the overalltreatment, as well as the capsulotomy, lens fragmentation, arcuateincisions, and/or cataract incisions treatments. Adjacent to eachprogress bar is a count-down timer that displays the remaining treatmenttime. Laser treatment can be paused at any time by pressing the PAUSETREATMENT button 526 on the control panel or by releasing the laserfootswitch 10. When laser treatment is paused, a “Clearable Error”message displays, and the user must press the OK button to acknowledgeand clear the error. To resume laser treatment, the user releases thelaser footswitch 10 and then presses it again.

When laser treatment is complete, the system automatically proceeds toUndocking Screens. The Undocking Screens guide the user through thepatient release procedure after laser treatment is complete or after theuser has begun undocking the patient. When the initial Undocking Screendisplays, the Vacuum panel 528 is open as shown in FIG. 82 . The openVacuum panel 528 displays instructions to release patient vacuum andlower the surgical chair.

When the system detects that patient vacuum has been released and thesurgical chair lowered, the check mark disappears in the Vacuum panel528, and the Capture panel 530 opens as shown in FIG. 83 . The Capturepanel 530 displays instructions to release and dispose of the suctionring. The user can either continue with the patient release procedure,or the user can press the GO TO REPORT button 532 to skip to theTreatment Report Summary Screen.

After the system verifies that patient vacuum has been released and thesurgical chair lowered, the Disposable Lens panel 534 opens as shown inFIG. 84 . The Disposable Lens panel 534 displays instructions to removethe disposable lens. After removing the disposable lens, the user canpress the GO TO REPORT button 532 to proceed to the Treatment ReportSummary Screen.

From any of the three Undocking Screens, the user can press the GO TOREPORT button 532 to access the Treatment Report Summary Screen, anexample of which is shown in FIG. 85 . If treatment was successfullycompleted, a check mark displays next to the icon(s) for the completedtreatments(s).

Capsulotomy Parameters

Capsulotomy parameters, including cut dimensions, laser settings andapplicable safety margins, are illustrated in FIGS. 86 and 87 andsummarized in Tables 1 and 2.

TABLE 1 User-Adjustable Capsulotomy Parameters Feature Default RangeStep Size Units Pattern Circle N/A N/A N/A Cut Depth 600 200-1000 200 μmDiameter N/A 2.0-8.0  0.1 mm Horizontal Spot Spacing 5 3-10 1 μmVertical Spot Spacing 10 5-50 5 μm Laser Pulse Energy 4 1-10 0.5 μJ

TABLE 2 Capsulotomy Safety Margins Feature Value Units Iris 500 μmCorneal 500 μm

Lens Fragmentation Parameters

Lens Fragmentation parameters, including cut dimensions for lenssegmentation and softening, laser settings, and applicable safetymargins, are illustrated in FIGS. 88 and 89 and summarized in FIG. 109and Tables 3 and 4.

TABLE 3 User-Adjustable Lens Fragmentation Parameters Feature DefaultRange Step Size Units Diameter * 3.0-10.0 0.5 mm Horizontal Spot Spacing10 5-25 2.5 μm Vertical Spot Spacing 40 10-100 10 μm Pulse Energy,Anterior** 8 1-10 0.5 μJ Pulse Energy, Posterior** 10 1-10 0.5 μJSeg-Soft Spacing 500 100-1500 100 μm Grid Spacing 500 100-2000 100 μm *Default diameter is defined by available pupil diameter - 2 * safetymargin. **Pulse energy to vary stepwise (linear) from posterior toanterior, if different

TABLE 4 Lens Fragmentation Safety Margins Feature Default Range StepSize Units Iris 500 N/A N/A μm Anterior *** 500 200-1000 100 μmPosterior *** 500 500-1000 100 μm *** Safety margins follow lens surfacecontours.

Arcuate and Cataract Incision Parameters

FIG. 90 shows an en face view of arcuate incisions 600, 602 within theoptical zone 604 of the cornea 606 that can be formed using the system2. The optical zone 606 is user-adjustable within the range of 2 mm-11mm. For asymmetric arcuate incisions, the optical zone 606 isindependently adjustable for each incision. Arc length 608 isuser-adjustable within the range of 10°-120°.

FIG. 91 shows a cross-sectional view of an arcuate incision 605 in thecornea 606 that can be formed using the system 2 and that penetrates thecornea anterior surface 609 and has an uncut posterior portion 610. FIG.92 shows a cross-sectional view of an arcuate intrastromal incision 611in the cornea 606 that can be formed using the system 2. The arcuateintrastromal incision 611 has an uncut anterior portion 612 and an uncutposterior portion 610. Side cut angle 614 is user-adjustable within therange of 30°-150°. Uncut posterior and anterior portions 610, 612 areuser-adjustable within the range of 100 μm-250 μm or 20%-50% of thecornea thickness. Cornea thickness is measured at the projectedintersection of the incision with the cornea anterior/posterior measuredat 90° to anterior/posterior cornea surface regardless of what side cutangle 614 is chosen.

FIG. 93 shows an en face view of a primary cataract incision 616 in thecornea 606 that can be formed using the system 2. The primary cataractincision 616 provides access to surgical tools used to, for example,remove the fragmented crystalline lens nucleus and insert an IOL. FIG.94 shows a cross-sectional view of a primary cataract incision 617 ofthe cornea 606 that can be formed using the system 2. Limbus offset 618is user-adjustable within the range of Width 620 is user-adjustablewithin the range 0.2 mm-6.5 mm. Length 622 is user-adjustable within therange of 0.5 mm-3.0 mm. Side Cut Angle 624 is user-adjustable within therange of 30°-150°. Plane depth 626 is user-adjustable within the rangeof 125 μm-375 μm or 25%-75% of the cornea thickness. Length 622 isdefined as the en face view distance between the projected incisionintersection with the cornea anterior and the cornea posterior. FIG. 95shows a cross-sectional view of a primary cataract incision 627 thatincludes an uncut anterior portion 628. FIG. 96 shows a cross-sectionalview of a primary cataract incision 629 that includes an uncut posteriorportion 630. FIG. 97 shows a cross-sectional view of a primary cataractincision 631 that includes an uncut central length 632. And FIG. 98shows a cross-sectional view of a primary cataract incision 634 thatincludes no uncut portion. Side Cut Angle 636 is user-adjustable withinthe range of 30°-150°. Uncut central length 632 is user-adjustablewithin the range of 25 μm-1000 μm.

FIG. 99 shows an en face view of a sideport cataract incision 638 in thecornea 606 that can be formed using the system 2. The sideport cataractincision 638 provides access for surgical tools used, for example, toassist in the removal of the fragmented crystalline lens. FIG. 100 showsa cross-sectional view of a sideport cataract incision 639 of the cornea606 that has an uncut posterior portion 640 and can be formed using thesystem 2. Limbus offset 642 is user-adjustable within the range of 0.0mm-5.0 mm. Width 644 is user-adjustable within the range 0.2 mm-6.5 mm.Length 645 is user-adjustable within the range of 0.5 mm-3.0 mm. FIG.101 shows a cross-sectional view of a sideport cataract incision 646that includes an uncut anterior portion 648. FIG. 102 shows across-sectional view of a sideport cataract incision 650 that includesan uncut central length 652. And FIG. 103 shows a cross-sectional viewof a sideport cataract incision 654 that includes no uncut portion. SideCut Angle 656, 658, 660 is user-adjustable within the range of 30°-150°.Uncut central length 652 is user-adjustable within the range of 100μm-250 μm or 20%-50% of the cornea thickness. Cornea thickness 662 ismeasured at the projected intersection location of the incision with thecornea anterior/posterior measured at 90° to the anterior/posteriorcornea surface regardless of what side cut angle is chosen.

FIGS. 104A, 104B, 104C, and 104D illustrate side cut angle methods forsideport cataract incisions. FIG. 104A illustrates aligning the sideportcataract incision 664 with the cornea posterior apex 666. FIG. 104Billustrates aligning the sideport cataract incision 668 with theanterior chamber center 670. FIG. 104C illustrates aligning the sideportcataract incision 672 with the lens apex 674. And FIG. 104D illustratesaligning the sideport cataract incision 676 with the lens center 679.

FIG. 105 illustrates a z-axis iris safety margin 680 for all cornealincisions. And FIG. 106 illustrates a lens anterior safety margin 682for all corneal incisions.

Table 5 contains user-adjustable parameters for arcuate incisions. Table6 contains user-adjustable parameters for primary cataract incisions.Table 7 contains user-adjustable parameters for sideport cataractincisions.

TABLE 5 User-adjustable parameters for arcuate incisions. FeatureDefault* Range Increment Step Size Units Incision Type N/A Single,Symmetric, Asymmetric N/A 0.5 N/A Axis** N/A  0-360 1 2.5 ° OpticalZone** N/A 2-11 0.1 10 mm Arc Length** N/A 10-120 1 0.5 ° CenteringMethod N/A Pupil, Limbus, Custom N/A 0.5 N/A Penetration Type AnteriorAnterior or Intrastromal N/A N/A N/A Depth Units Percentage Percentageor Absolute N/A N/A N/A Uncut Anterior*** 20%  20-50% 1 2 % 100 100-250 1 10 μm Uncut Posterior 20%  20-50% 1 2 % 100 100-250  1 10 μm Side CutAngle 90 30-150 1 5 ° Horizontal Spot Spacing 10 5-50 1 5 μm VerticalSpot Spacing 20 10-50  1 5 μm Pulse Energy 5 3-10 0.1 0.5 μJ *Parametersdo not have default values; user must select each parameter.**Independently adjustable parameters for asymmetric incisions. ***Notapplicable for anterior penetrating.

TABLE 6 User-adjustable parameters for primary cataract incisions.Feature Default* Range Increment Step Size Units Axis N/A  0-360 1 5 °Limbus Offset N/A 0.0-5.0 0.1 0.1 mm Width 2.2 0.2-6.5 0.1 0.1 mm Length2.2 0.5-3.0 0.1 0.1 mm Uncut Region Central Anterior, Central, N/A N/AN/A Posterior, None Depth Units Percentage Percentage or Absolute N/AN/A N/A Uncut Anterior/ 20%    20-50% 1% 5% % Uncut Posterior 100100-250 1 25 μm Uncut Central Length* 100  25-1000 1 25 μm Plane Depth50%    25-75% 1% 5% % 250 125-375 1 50 μm Side Cut Angle 120  30-150 1 5° Horizontal Spot Spacing 10  5-50 1 5 μm Vertical Spot Spacing 20 10-501 5 μm Pulse Energy 5  3-10 0.1 0.5 μJ *If the uncut central length islonger than the length parameter, then the uncut central length will beset as equal to the length parameter.

TABLE 7 User-adjustable parameters for sideport cataract incisions.Feature Default* Range Increment Step Units Number of Incisions N/A 0-61 1 N/A Axis* N/A (0)  0-360 1 5 ° Limbus Offset* N/A (1.0) 0.0-5.0 0.10.1 mm Width* N/A (0.5) 0.2-6.5 0.1 0.1 mm Uncut Type Central Anterior,Central, N/A N/A N/A Posterior, None Uncut Units Percentage Percentageor Absolute N/A N/A N/A Uncut Length 20%    20-50% 1% 2% % (Anterior,Posterior, 100 100-250 1 10 μm Side Cut Angle Type Lens Apex CorneaPosterior Apex, N/A N/A N/A AC Center, Lens Apex, Lens Center, CustomCustom Side Cut Angle 90  30-150 1 5 ° Horizontal Spot 10  5-50 1 5 μmSpacing Vertical Spot Spacing 20 10-50 1 5 μm Pulse Energy 5  3-10 0.10.5 μJ *Individually adjustable for each sideport cataract incision.

While preferred embodiments of the present invention have been shown anddescribed herein, it will be obvious to those skilled in the art thatsuch embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the invention. It should be understoodthat various alternatives to the embodiments of the invention describedherein may be employed in practicing the invention. It is intended thatthe following claims define the scope of the invention and that methodsand structures within the scope of these claims and their equivalents becovered thereby.

1.-18. (canceled)
 19. A system for planning and performing a lasersurgery procedure on an eye having a cornea, a pupil, and a lens, thecornea having an anterior surface and a posterior surface, the lensbeing disposed within a lens capsule having an anterior portion and aposterior portion, the system comprising: a laser source configured toproduce a treatment beam that includes a plurality of laser pulses; anintegrated optical system that includes an imaging assembly operativelycoupled to a treatment laser delivery assembly for the treatment beamsuch that the imaging assembly and the treatment laser delivery systemshare at least one common optical element, the integrated optical systembeing configured to locate at least a portion of the corneal anteriorsurface and at least a portion of the corneal posterior surface, and tolocate at least a portion of an anterior portion of the lens capsule; apatient interface configured to couple the eye with the integratedoptical system so as to constrain the position of the eye relative tothe integrated optical system; a display device; and a controlleroperatively coupled with the display device, the laser source, and theintegrated optical system; the controller being configured to: generate,relative to the integrated optical system, a spatial disposition of thecorneal anterior surface and a spatial disposition of the cornealposterior surface by using the integrated optical system to locate atleast portions of the corneal anterior and posterior surfaces; generatea spatial disposition of an incision of the cornea using the generatedspatial dispositions of the corneal anterior and posterior surfaces andat least one corneal incision parameter; display a composite image onthe display device, the composite image including an imagerepresentative of the generated spatial dispositions of the cornealanterior and posterior surfaces and an image representing the cornealincision; generate a spatial disposition of at least a portion of theanterior portion of the lens capsule by using the integrated opticalsystem to locate at least a portion of the anterior portion of the lenscapsule; generate a spatial disposition of a capsulotomy incision of theanterior portion of the lens capsule using the generated spatialdisposition of the anterior portion of the lens capsule and at least onecapsulotomy parameter; and display a third composite image on thedisplay device, the third composite image including an imagerepresentative of the generated spatial disposition of the anteriorportion of the lens capsule and an image representing the capsulotomyincision.
 20. The system of claim 19, wherein the at least onecapsulotomy parameter includes a capsulotomy line density parameter tocontrol amount of overlap between adjacent lines of laser pulse focuspoints that will be used to form the capsulotomy incision.
 21. Thesystem of claim 19, further comprising a user input device, thecontroller being further configured to: alter the at least onecapsulotomy parameter in response to user input via the user inputdevice; generate a spatial disposition of an altered capsulotomyincision of the anterior portion of the lens capsule using the generatedanterior lens capsule spatial disposition and the altered capsulotomyparameter; and display a fourth composite image on the display device,the fourth composite image including an image representative of thegenerated spatial disposition of the anterior portion of the lenscapsule and an image representing the altered capsulotomy incision. 22.The system of claim 19, wherein the integrated optical system isconfigured to locate at least a portion of the posterior portion of thelens capsule, the controller being further configured to: generate aspatial disposition of at least a portion of the posterior portion ofthe lens capsule by using the integrated optical system to locate atleast the portion of the posterior portion of the lens capsule; generatea spatial disposition of a lens fragmentation incision pattern of thelens using the generated spatial disposition of the posterior portion ofthe lens capsule and at least one lens fragmentation parameter; anddisplay a fifth composite image on the display device, the fifthcomposite image including an image representative of the generatedspatial dispositions of the anterior and posterior portions of the lenscapsule and an image representing the lens fragmentation incisionpattern.
 23. The system of claim 22, wherein the at least one lensfragmentation parameter includes a lens fragmentation line densityparameter to control amount of overlap between adjacent lines of laserpulse focus points that will be used to form the lens fragmentationincision pattern.
 24. The system of claim 22, further comprising a userinput device, the controller being further configured to: alter the atleast one lens fragmentation parameter in response to user input via theuser input device; generate a spatial disposition of an altered lensfragmentation incision pattern using the generated spatial dispositionsof the anterior and posterior portions of the lens capsule and thealtered at least one lens fragmentation parameter; and display a sixthcomposite image on the display device, the sixth composite imageincluding an image representative of the generated spatial dispositionsof the corneal anterior and posterior surfaces and an image representingthe altered lens fragmentation incision pattern.
 25. The system of claim22, the controller being further configured to: generate a spatialdisposition a safety volume within the lens, the incision pattern notoverlapping the safety volume, the safety volume separating the lensfragmentation incision pattern from the anterior and posterior portionsof the lens capsule and separating the lens fragmentation patterntransverse to the pupil such that a maximum transverse width of the lensfragmentation pattern is less than a diameter of the pupil; and displaya safety volume image that includes a representation of the safetyvolume.
 26. The system of claim 22, wherein the controller is furtherconfigured to: prior to coupling the eye to the integrated opticalsystem, generate a spatial disposition a safety volume within the lens,the incision pattern not overlapping the safety volume, the safetyvolume separating the lens fragmentation incision pattern from theanterior and posterior portions of the lens capsule and separating thelens fragmentation pattern transverse to the pupil such that a maximumtransverse width of the lens fragmentation pattern is less than adiameter of the pupil; and display a safety volume image that includes arepresentation of the safety volume.
 27. A system for planning andperforming a laser surgery procedure on an eye having a cornea, a pupil,and a lens, the cornea having an anterior surface and a posteriorsurface, the lens being disposed within a lens capsule having ananterior portion and a posterior portion, the system comprising: a lasersource configured to produce a treatment beam that includes a pluralityof laser pulses; an integrated optical system that includes an imagingassembly operatively coupled to a treatment laser delivery assembly forthe treatment beam such that the imaging assembly and the treatmentlaser delivery system share at least one common optical element, theintegrated optical system being configured to locate at least a portionof the corneal anterior surface and at least a portion of the cornealposterior surface; a patient interface configured to couple the eye withthe integrated optical system so as to constrain the position of the eyerelative to the integrated optical system; a display device; and acontroller operatively coupled with the display device, the lasersource, and the integrated optical system; the controller beingconfigured to: generate and display a first cross-sectional image of theeye based at least in part on spatial dispositions of the cornea andlens capsule measured by the integrated optics system, the firstcross-sectional image including at least one of a cross section of thecornea and a cross section of a central portion of the lens capsule;receive user input designating a plurality of points in the firstcross-sectional image corresponding to points on a boundary surface ofthe cornea or the lens capsule; generate and display a secondcross-sectional image of the eye based at least in part on the measuredspatial dispositions of the cornea and lens capsule, the secondcross-sectional image being transverse to the first cross-sectionalimage and including at least one of a cross section of the cornea and across section of a central portion of the lens capsule; receive userinput designating a plurality of points in the second cross-sectionalimage corresponding to points on the boundary surface; generate asurface model of the boundary surface based at least in part on the userdesignated points; and generate a spatial disposition of an incision ofthe cornea or the lens capsule based at least in part on the surfacemodel and at least one incision parameter.
 28. The system of claim 22,the controller being further configured to: prior to coupling the eye tothe integrated optical system, displaying a seventh composite image thatincludes an image representative of the eye and at least one of an imagerepresenting an incision of the cornea corresponding to the at least onecorneal incision parameter, an image representing an incision of theanterior portion of the lens capsule corresponding to the at least onecapsulotomy parameter, or an image representing a lens fragmentationincision pattern corresponding to the at least one lens fragmentationparameter.